1
|
Naz H, Nijhawan R, Ahuja NJ. Clinical utility of handheld fundus and smartphone-based camera for monitoring diabetic retinal diseases: a review study. Int Ophthalmol 2024; 44:41. [PMID: 38334896 DOI: 10.1007/s10792-024-02975-4] [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: 05/08/2023] [Accepted: 10/29/2023] [Indexed: 02/10/2024]
Abstract
Diabetic retinopathy (DR) is the leading global cause of vision loss, accounting for 4.8% of global blindness cases as estimated by the World Health Organization (WHO). Fundus photography is crucial in ophthalmology as a diagnostic tool for capturing retinal images. However, resource and infrastructure constraints limit access to traditional tabletop fundus cameras in developing countries. Additionally, these conventional cameras are expensive, bulky, and not easily transportable. In contrast, the newer generation of handheld and smartphone-based fundus cameras offers portability, user-friendliness, and affordability. Despite their potential, there is a lack of comprehensive review studies examining the clinical utilities of these handheld (e.g. Zeiss Visuscout 100, Volk Pictor Plus, Volk Pictor Prestige, Remidio NMFOP, FC161) and smartphone-based (e.g. D-EYE, iExaminer, Peek Retina, Volk iNview, Volk Vistaview, oDocs visoScope, oDocs Nun, oDocs Nun IR) fundus cameras. This review study aims to evaluate the feasibility and practicality of these available handheld and smartphone-based cameras in medical settings, emphasizing their advantages over traditional tabletop fundus cameras. By highlighting various clinical settings and use scenarios, this review aims to fill this gap by evaluating the efficiency, feasibility, cost-effectiveness, and remote capabilities of handheld and smartphone fundus cameras, ultimately enhancing the accessibility of ophthalmic services.
Collapse
Affiliation(s)
- Huma Naz
- Department of Computer Science, University of Petroleum and Energy Studies, Dehradun, India.
| | - Rahul Nijhawan
- Thapar Institute of Engineering and Technology, Patiala, Punjab, India
| | - Neelu Jyothi Ahuja
- Department of Computer Science, University of Petroleum and Energy Studies, Dehradun, India
| |
Collapse
|
2
|
Kadakia A, Zhang J, Yao X, Zhou Q, Heiferman MJ. Ultrasound in ocular oncology: Technical advances, clinical applications, and limitations. Exp Biol Med (Maywood) 2023; 248:371-379. [PMID: 37212384 PMCID: PMC10281622 DOI: 10.1177/15353702231169539] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Due to its accessibility and ability for real-time image acquisition of ocular structures, ultrasound has high utility in the visualization of the eye, especially in ocular oncology. In this minireview, we summarize the technical rationale and applications of ultrasound modalities, A-scan, B-scan, high-frequency ultrasound biomicroscopy (UBM), and Doppler measurement. A-scan ultrasound uses a transducer of 7-11 MHz, making it useful for determining the echogenicity of ocular tumors (7-8 MHz) and measuring the axial length of the eye (10-11 MHz). B-scan ultrasound operates at 10-20 MHz, which can be used for measuring posterior ocular tumors while UBM operates at 40-100 MHz to evaluate anterior ocular structures. Doppler ultrasonography allows for the detection of tumor vascularization. While ultrasonography has numerous clinical applications due to its favorable penetration compared with optical coherence tomography, it is still limited by its relatively lower resolution. Ultrasound also requires an experienced sonographer due to the need for accurate probe localization to areas of interest.
Collapse
Affiliation(s)
- Arya Kadakia
- Department of Ophthalmology and Visual
Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL 60612,
USA
| | - Junhang Zhang
- Department of Biomedical Engineering, Viterbi
School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Xincheng Yao
- Department of Ophthalmology and Visual
Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL 60612,
USA
- Department of Biomedical Engineering,
University of Illinois Chicago, Chicago, IL 60607, USA
| | - Qifa Zhou
- Department of Biomedical Engineering, Viterbi
School of Engineering, University of Southern California, Los Angeles, CA 90089, USA
| | - Michael J Heiferman
- Department of Ophthalmology and Visual
Sciences, Illinois Eye and Ear Infirmary, University of Illinois Chicago, Chicago, IL 60612,
USA
| |
Collapse
|
3
|
Lu L, Ausayakhun S, Ausayakuhn S, Khunsongkiet P, Apivatthakakul A, Sun CQ, Kim TN, Lee M, Tsui E, Sutra P, Keenan JD. Diagnostic accuracy of handheld fundus photography: A comparative study of three commercially available cameras. PLOS DIGITAL HEALTH 2022; 1:e0000131. [PMID: 36812561 PMCID: PMC9931246 DOI: 10.1371/journal.pdig.0000131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 09/19/2022] [Indexed: 06/18/2023]
Abstract
The objective of this study was to compare the sensitivity and specificity of handheld fundus cameras in detecting diabetic retinopathy (DR), diabetic macular edema (DME), and macular degeneration. Participants in the study, conducted at Maharaj Nakorn Hospital in Northern Thailand between September 2018 and May 2019, underwent an ophthalmologist examination as well as mydriatic fundus photography with three handheld fundus cameras (iNview, Peek Retina, Pictor Plus). Photographs were graded and adjudicated by masked ophthalmologists. Outcome measures included the sensitivity and specificity of each fundus camera for detecting DR, DME, and macular degeneration, relative to ophthalmologist examination. Fundus photographs of 355 eyes from 185 participants were captured with each of the three retinal cameras. Of the 355 eyes, 102 had DR, 71 had DME, and 89 had macular degeneration on ophthalmologist examination. The Pictor Plus was the most sensitive camera for each of the diseases (73-77%) and also achieved relatively high specificity (77-91%). The Peek Retina was the most specific (96-99%), although in part due to its low sensitivity (6-18%). The iNview had slightly lower estimates of sensitivity (55-72%) and specificity (86-90%) compared to the Pictor Plus. These findings demonstrated that the handheld cameras achieved high specificity but variable sensitivities in detecting DR, DME, and macular degeneration. The Pictor Plus, iNview, and Peek Retina would have distinct advantages and disadvantages when applied for utilization in tele-ophthalmology retinal screening programs.
Collapse
Affiliation(s)
- Louisa Lu
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, Stanford University, Stanford, California, United States of America
| | - Somsanguan Ausayakhun
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- CMU Lasik Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sakarin Ausayakuhn
- Sriphat Medical Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Atitaya Apivatthakakul
- Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Catherine Q. Sun
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
| | - Tyson N. Kim
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
| | - Michele Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington, United States of America
| | - Edmund Tsui
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
| | - Plern Sutra
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Jeremy D. Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, United States of America
| |
Collapse
|
4
|
Biousse V, Danesh-Meyer HV, Saindane AM, Lamirel C, Newman NJ. Imaging of the optic nerve: technological advances and future prospects. Lancet Neurol 2022; 21:1135-1150. [DOI: 10.1016/s1474-4422(22)00173-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 01/02/2023]
|
5
|
Yeh TC, Lo KJ, Hwang DK, Lin TC, Chou YB. Evaluation of a remote telemedicine platform using a novel handheld fundus camera: Physician and patient perceptions from real-world experience. J Chin Med Assoc 2022; 85:793-798. [PMID: 35648158 DOI: 10.1097/jcma.0000000000000755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Although teleophthalmology has gained traction in recent years, it is at the center of the coronavirus disease pandemic. However, most hospitals are not ready owing to a severe lack of real-world experience. Furthermore, a limited number of studies have evaluated telemedicine applications on remote islands. This study aimed to evaluate real-world clinical and referral accuracy, image quality, physician-perceived diagnostic certainty, and patient satisfaction with telemedicine eye screening using a novel handheld fundus camera in a rural and medically underserved population. METHODS This prospective study included 176 eyes from a remote island. All participants underwent a comprehensive ophthalmic examination. Nonmydriatic retinal images obtained using a handheld fundus camera were reviewed by two retinal specialists to determine image quality, diagnosis, and need for referrals. The agreement of diagnosis between image-based assessments was compared with that of binocular indirect ophthalmoscopic assessments. RESULTS Image quality of fundus photographs was considered acceptable or ideal in 97.7% and 95.5% of eyes assessed by two reviewers, respectively. There was considerable agreement in diagnosis between the indirect ophthalmoscopic assessment and image-based assessment by two reviewers (Cohen's kappa = 0.80 and 0.78, respectively). Likewise, substantial agreement was achieved in the referrals. The sensitivity for referable retinopathy from the two reviewers was 78% (95% confidence interval [CI], 57%-91%) and 78% (95% CI, 57%-91%), whereas specificity was 99% (95% CI, 95%-99%] and 98% (95% CI, 93%-99%), respectively. For physicians' perceived certainty of diagnosis, 93.8% and 90.3% were considered either certain or reliable. Overall, 97.4% of participants were satisfied with their experiences and greatly valued the telemedicine services. CONCLUSION Novel fundus camera-based telemedicine screening demonstrated high accuracy in detecting clinically significant retinopathy in real-world settings. It achieved high patient satisfaction and physician-perceived certainty in diagnosis with reliable image quality, which may be scaled internationally to overcome geographical barriers under the global pandemic.
Collapse
Affiliation(s)
- Tsai-Chu Yeh
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Kang-Jung Lo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - De-Kuang Hwang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tai-Chi Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Bai Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
6
|
He G, Dunn HP, Ahmad KE, Watson E, Henderson A, Tynan D, Leaney J, White AJ, Hewitt AW, Fraser CL. Fundoscopy Use in Neurology Departments and the Utility of Smartphone photography (
FUNDUS
): A prospective prevalence and crossover diagnostic accuracy study amongst neurology inpatients. Eur J Neurol 2022; 29:2463-2472. [PMID: 35531644 PMCID: PMC9541490 DOI: 10.1111/ene.15390] [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: 11/05/2021] [Revised: 02/13/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Although fundoscopy is a crucial part of the neurological examination, it is challenging, under‐utilized and unreliably performed. The aim was to determine the prevalence of fundus pathology amongst neurology inpatients and the diagnostic accuracy of current fundoscopy practice compared with systematic screening with smartphone fundoscopy (SF) and portable non‐mydriatic fundus photography (NMFP). Methods This was a prospective cross‐sectional surveillance and diagnostic accuracy study on adult patients admitted under neurology in an Australian hospital. Inpatients were randomized to initial NMFP (RetinaVue 100, Welch Allyn) or SF (D‐EYE) followed by a crossover to the alternative modality. Images were graded by neurology doctors, using telemedicine consensus neuro‐ophthalmology NMFP grading as the reference standard. Feasibility parameters included ease, comfort and speed. Results Of 79 enrolled patients, 14.1% had neurologically relevant pathology (seven, disc pallor; one, hypertensive retinopathy; three, disc swelling). The neurology team performed direct ophthalmoscopy in 6.6% of cases and missed all abnormalities. SF had a sensitivity of 30%–40% compared with NMFP (45.5%); however, it had a lower rate of screening failure (1% vs. 13%, p < 0.001), a shorter examination time (1.10 vs. 2.25 min, p < 0.001) and a slightly higher patient comfort rating (9.2 vs. 8/10, p < 0.001). Conclusion Our study demonstrates a clinically significant prevalence of fundus pathology amongst neurology inpatients which was missed by current fundoscopy practices. Portable NMFP screening appears more accurate than SF, whilst both are diagnostically superior to routine fundoscopic practice, feasible and well tolerated by patients.
Collapse
Affiliation(s)
- George He
- The University of Melbourne Melbourne (Vic) Australia
| | - Hamish P. Dunn
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Westmead Hospital, (Department of Ophthalmology), Sydney, (NSW) Australia
- The University of New South Wales (Rural Clinical School) Port Macquarie (NSW) Australia
| | - Kate E. Ahmad
- Royal North Shore Hospital, (Department of Neurology), Sydney, (NSW) Australia
| | - Eloise Watson
- Royal North Shore Hospital, (Department of Neurology), Sydney, (NSW) Australia
| | - Andrew Henderson
- Westmead Hospital, (Department of Neurology), Sydney, (NSW) Australia
| | - Dominique Tynan
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Royal Victorian Eye & Ear Hospital, (Vic) Australia
| | - John Leaney
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Westmead Hospital, (Department of Ophthalmology), Sydney, (NSW) Australia
| | - Andrew J. White
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Westmead Hospital, (Department of Ophthalmology), Sydney, (NSW) Australia
- Centre for Vision Research Westmead Institute for Medical Research Sydney
| | - Alex W. Hewitt
- The University of Melbourne Melbourne (Vic) Australia
- Centre for Eye Research Melbourne (Vic) Australia
| | - Clare L. Fraser
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Save Sight Institute Sydney, The University of Sydney, (NSW) Australia
| |
Collapse
|
7
|
Muro-Fuentes EA, Stunkel L. Diagnostic Error in Neuro-ophthalmology: Avenues to Improve. Curr Neurol Neurosci Rep 2022; 22:243-256. [PMID: 35320466 PMCID: PMC8940596 DOI: 10.1007/s11910-022-01189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/06/2022]
Abstract
Purpose of Review To highlight potential avenues to reduce preventable diagnostic error of neuro-ophthalmic conditions and avoid patient harm. Recent Findings Recent prospective studies and studies of patient harm have advanced our understanding. Additionally, recent studies of fundus photography, telemedicine, and artificial intelligence highlight potential avenues for diagnostic improvement. Summary Diagnostic error of neuro-ophthalmic conditions can often be traced to failure to gather an adequate history, perform a complete physical exam, obtain adequate/appropriate neuroimaging, and generate a complete, appropriate differential diagnosis. Improving triage and identification of neuro-ophthalmic conditions by other providers and increasing access to subspecialty neuro-ophthalmology evaluation are essential avenues to reduce diagnostic error. Further research should evaluate the relationship between misdiagnosis and patient harm, and help identify the most impactful potential targets for improvement.
Collapse
Affiliation(s)
| | - Leanne Stunkel
- John F. Hardesty, MD Department of Ophthalmology and Visual Sciences and Department of Neurology, Washington University in St. Louis, 660 S. Euclid Ave, Campus Box 8096, St. Louis, MO, 63110, USA
| |
Collapse
|
8
|
Sensitivity and Specificity of Handheld Fundus Cameras for Eye Disease: A Systematic Review and Pooled Analysis. Surv Ophthalmol 2021; 67:1531-1539. [PMID: 34822849 DOI: 10.1016/j.survophthal.2021.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 11/21/2022]
Abstract
In order to evaluate the accuracy of commercially available handheld fundus cameras for a variety of ophthalmic diagnoses, we conducted a systematic review, searching PubMed and PubMed Central and performing a bivariate analysis to determine the pooled sensitivity and specificity of handheld fundus cameras. Eleven studies validating handheld fundus cameras against a gold-standard method for disease diagnosis were included. For non-mydriatic images, pooled sensitivity was 83% (95% CI: 77-88%) and specificity was 92% (95% CI: 79-97%). For mydriatic images, pooled sensitivity was 87% (95% CI: 79-92%) and specificity was 90% (95% CI: 78-96%). Overall pooled sensitivity was 85% (95% CI: 80-89%) and specificity was 91% (95% CI: 83-95%). Of the 11 studies included, 5 assessed the diagnosis of diabetic retinopathy, for which sensitivity was 87% (95% CI: 80-92%) and specificity was 95% (95% CI: 85-98%). For all other diagnoses combined, sensitivity was 81% (95% CI: 74-87%) and specificity was 83% (95% CI: 76-89%). These findings suggest that handheld fundus cameras are capable of achieving acceptable sensitivity and specificity values for eye disease, with mydriatic images being more sensitive for disease. Diabetic retinopathy was the single diagnosis with the strongest data to support the use of handheld fundus cameras for disease screening.
Collapse
|
9
|
Choi KY, Wong HHY, Chan HHL. Utilizing Advanced Technology to Facilitate Diagnosis of Rare Retinal Disorders: A Case of Bietti Crystalline Dystrophy. Optom Vis Sci 2021; 98:1031-1038. [PMID: 34459467 DOI: 10.1097/opx.0000000000001763] [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: 11/26/2022] Open
Abstract
SIGNIFICANCE Optometrists, as primary eye care providers, encounter patients with rare ocular disease such as Bietti crystalline dystrophy from time to time. Using advanced technologies, which are also useful in managing common ocular conditions, to facilitate a prompt diagnosis is highly recommended. PURPOSE This report describes a patient with clinically diagnosed Bietti crystalline dystrophy with findings on funduscopy, multimodal imaging, and visual electrophysiology. CASE REPORT A 41-year-old Chinese woman who had subjectively progressing dimmed vision (especially in the left eye) for 9 months was referred to our clinic to test for retinitis pigmentosa. Best-corrected visual acuities were 6/6 and 6/7.6 in the right and left eyes, respectively. Funduscopy revealed multiple crystalline deposits on the posterior pole in both eyes. The 30-2 perimetry displayed bi-inferotemporal scotoma (left > right eye). Scotopic flash electroretinogram (ERG) yielded a normal result, whereas photopic ERG was slightly attenuated. Electro-oculogram showed an abnormal adaptation time course of the retinal pigmented epithelium (RPE). Multifocal ERG revealed a decreased central retinal response, but paracentral responses were relatively better preserved. Optical coherence tomography showed multiple patches of RPE atrophy, with disruption of the left ellipsoid zone. Outer retinal tubulations, hyperreflective dots on RPE-Bruch's membrane interface, and intraretinal bright spots were also identified. CONCLUSIONS Rare ocular diseases like Bietti crystalline dystrophy can be encountered by optometrists. This case report shows the ophthalmic findings of a rare chorioretinal dystrophy and provides insight on how to better use advanced equipment in an optometric practice to facilitate prompt diagnoses.
Collapse
Affiliation(s)
- Kai Yip Choi
- Laboratory of Experimental Optometry (Neuroscience), School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Horace Ho Yin Wong
- Laboratory of Experimental Optometry (Neuroscience), School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | | |
Collapse
|
10
|
Lee T, Jammal AA, Mariottoni EB, Medeiros FA. Predicting Glaucoma Development With Longitudinal Deep Learning Predictions From Fundus Photographs. Am J Ophthalmol 2021; 225:86-94. [PMID: 33422463 DOI: 10.1016/j.ajo.2020.12.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To assess whether longitudinal changes in a deep learning algorithm's predictions of retinal nerve fiber layer (RNFL) thickness based on fundus photographs can predict future development of glaucomatous visual field defects. DESIGN Retrospective cohort study. METHODS This study included 1,072 eyes of 827 glaucoma-suspect patients with an average follow-up of 5.9 ± 3.8 years. All eyes had normal standard automated perimetry (SAP) at baseline. Additional SAP and fundus photographs were acquired throughout follow-up. Conversion to glaucoma was defined as repeatable glaucomatous defects on SAP. An OCT-trained deep learning algorithm (machine to machine, M2M) was used to predict RNFL thicknesses from fundus photographs. Joint longitudinal survival models were used to assess whether baseline and longitudinal change in M2M's RNFL thickness estimates could predict development of visual field defects. RESULTS A total of 196 eyes (18%) converted to glaucoma during follow-up. The mean rate of change in M2M's predicted RNFL thickness was -1.02 μm/y for converters and -0.67 μm/y for non-converters (P < .001). Baseline and rate of change of predicted RNFL thickness were significantly predictive of conversion to glaucoma, with hazard ratios in the multivariable model of 1.56 per 10 μm lower at baseline (95% CI, 1.33-1.82; P < .001) and 1.99 per 1 μm/y faster loss in thickness during follow-up (95% CI, 1.36-2.93; P < .001). CONCLUSION Longitudinal changes in a deep learning algorithm's predictions of RNFL thickness measurements based on fundus photographs can be used to predict risk of glaucoma conversion in eyes suspected of having the disease.
Collapse
|
11
|
Chong JC, Tan CHN, Chen DZ. Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping
review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
ABSTRACT
Introduction: Teleophthalmology may assist the healthcare sector in adapting to limitations imposed on
clinical practice by a viral pandemic. A scoping review is performed in this study to assess the current
applications of teleophthalmology for its suitability to diagnose, monitor or manage ophthalmological
conditions with accuracy.
Methods: A search of PubMed was conducted for teleophthalmology-related articles published from
1 January 2018 to 4 May 2020. Only articles that focused on the use of teleophthalmology in terms of
diagnosis and management, as well as its benefits and detriments, were included. The Mixed Methods
Appraisal Tool (MMAT) was used to assess the quality of the included articles.
Results: A total of 38 articles were assessed at the full-text level. There were 2 qualitative studies and
1 quantitative randomised controlled trial, while the majority were either quantitative descriptive studies
(19, 50.0%) or quantitative non-randomised studies (16, 42.1%). Overall, 8 studies described reducing
manpower requirements, 4 described reducing direct patient–doctor contact, 17 described storage of
medical imaging and clinical data, and 9 described real-time teleconferencing. The MMAT analysis
revealed limitations in appropriate sampling strategy in both quantitative non-randomised studies (9 of
16, 56.3%) and quantitative descriptive studies (9 of 19, 47.4%). Cost-effectiveness of teleophthalmology
was not performed in any included study.
Conclusion: This current review of the various aspects of teleophthalmology describes how it may
potentially assist the healthcare sector to cope with the limitations imposed by a viral pandemic through
technology. Further research is required to evaluate the cost-effectiveness of the various strategies.
Keywords: Artificial intelligence, health informatics, ophthalmology, teleconsultation, telemedicine
Collapse
|
12
|
Hu H, Wei H, Xiao M, Jiang L, Wang H, Jiang H, Rundek T, Wang J. Characterization of the retinal vasculature in fundus photos using the PanOptic iExaminer system. EYE AND VISION (LONDON, ENGLAND) 2020; 7:46. [PMID: 32944589 PMCID: PMC7487633 DOI: 10.1186/s40662-020-00211-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 08/17/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND The goal was to characterize retinal vasculature by quantitative analysis of arteriole-to-venule (A/V) ratio and vessel density in fundus photos taken with the PanOptic iExaminer System. METHODS The PanOptic ophthalmoscope equipped with a smartphone was used to acquire fundus photos centered on the optic nerve head. Two fundus photos of a total of 19 eyes from 10 subjects were imaged. Retinal vessels were analyzed to obtain the A/V ratio. In addition, the vessel tree was extracted using deep learning U-NET, and vessel density was processed by the percentage of pixels within vessels over the entire image. RESULTS All images were successfully processed for the A/V ratio and vessel density. There was no significant difference of averaged A/V ratio between the first (0.77 ± 0.09) and second (0.77 ± 0.10) measurements (P = 0.53). There was no significant difference of averaged vessel density (%) between the first (6.11 ± 1.39) and second (6.12 ± 1.40) measurements (P = 0.85). CONCLUSIONS Quantitative analysis of the retinal vasculature was feasible in fundus photos taken using the PanOptic ophthalmoscope. The device appears to provide sufficient image quality for analyzing A/V ratio and vessel density with the benefit of portability, easy data transferring, and low cost of the device, which could be used for pre-clinical screening of systemic, cerebral and ocular diseases.
Collapse
Affiliation(s)
- Huiling Hu
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| | - Haicheng Wei
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL USA
- School of Electrical and Information Engineering, North Minzu University, Yinchuan, Ningxia China
| | - Mingxia Xiao
- Department of Electrical and Computer Engineering, Florida International University, Miami, FL USA
- School of Electrical and Information Engineering, North Minzu University, Yinchuan, Ningxia China
| | - Liqiong Jiang
- Shenzhen Key Laboratory of Ophthalmology, Shenzhen Eye Hospital, Jinan University, Shenzhen, China
| | - Huijuan Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
- Eye hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hong Jiang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL USA
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL USA
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 1638 NW 10th Avenue, McKnight Building - Room 202A, Miami, FL 33136 USA
| |
Collapse
|
13
|
Sommer AC, Blumenthal EZ. Telemedicine in ophthalmology in view of the emerging COVID-19 outbreak. Graefes Arch Clin Exp Ophthalmol 2020; 258:2341-2352. [PMID: 32813110 PMCID: PMC7436071 DOI: 10.1007/s00417-020-04879-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 01/08/2023] Open
Abstract
Purpose Technological advances in recent years have resulted in the development and implementation of various modalities and techniques enabling medical professionals to remotely diagnose and treat numerous medical conditions in diverse medical fields, including ophthalmology. Patients who require prolonged isolation until recovery, such as those who suffer from COVID-19, present multiple therapeutic dilemmas to their caregivers. Therefore, utilizing remote care in the daily workflow would be a valuable tool for the diagnosis and treatment of acute and chronic ocular conditions in this challenging clinical setting. Our aim is to review the latest technological and methodical advances in teleophthalmology and highlight their implementation in screening and managing various ocular conditions. We present them as well as potential diagnostic and treatment applications in view of the recent SARS-CoV-2 virus outbreak. Methods A computerized search from January 2017 up to March 2020 of the online electronic database PubMed was performed, using the following search strings: “telemedicine,” “telehealth,” and “ophthalmology.” More generalized complementary contemporary research data regarding the COVID-19 pandemic was also obtained from the PubMed database. Results A total of 312 records, including COVID-19-focused studies, were initially identified. After exclusion of non-relevant, non-English, and duplicate studies, a total of 138 records were found eligible. Ninety records were included in the final qualitative analysis. Conclusion Teleophthalmology is an effective screening and management tool for a range of adult and pediatric acute and chronic ocular conditions. It is mostly utilized in screening of retinal conditions such as retinopathy of prematurity, diabetic retinopathy, and age-related macular degeneration; in diagnosing anterior segment condition; and in managing glaucoma. With improvements in image processing, and better integration of the patient’s medical record, teleophthalmology should become a more accepted modality, all the more so in circumstances where social distancing is inflicted upon us. ![]()
Collapse
Affiliation(s)
- Adir C Sommer
- Department of Ophthalmology, Rambam Health Care Campus, P.O.B 9602, 31096, Haifa, Israel
| | - Eytan Z Blumenthal
- Department of Ophthalmology, Rambam Health Care Campus, P.O.B 9602, 31096, Haifa, Israel. .,Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| |
Collapse
|
14
|
Safadi K, Kruger JM, Chowers I, Solomon A, Amer R, Aweidah H, Frenkel S, Mechoulam H, Anteby I, Ben Eli H, Lavy I, Jaouni T, Landau D, Tiosano L, Greifner G, Ofir S, Levi Vineberg T, Levy J. Ophthalmology practice during the COVID-19 pandemic. BMJ Open Ophthalmol 2020; 5:e000487. [PMID: 32432169 PMCID: PMC7222613 DOI: 10.1136/bmjophth-2020-000487] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/08/2020] [Indexed: 12/22/2022] Open
Abstract
Objective To present an established practice protocol for safe and effective hospital-setting ophthalmic practice during the coronavirus disease 2019 (COVID-19) pandemic. Methods and Analysis Literature was reviewed to identify articles relevant to COVID-19 pandemic and ophthalmology. The following keywords were used: COVID-19, SARS-CoV-2 and telemedicine, combined with eye, ophthalmology, conjunctivitis and tears. Data were extracted from the identified manuscripts and discussed among subspecialists to obtain consensus evidence-based practice. Results A protocol for ophthalmic practice in the era of COVID-19 pandemic was established. The protocol covered patient screening, clinic flow, required personal protective equipment and modifications of ophthalmic equipment for improved safety. Conclusion Important literature emerged with respect to the practice of ophthalmology in the era of COVID-19. An evidence-based ophthalmic practice protocol was established and should be modified in the future to accommodate new insights on the COVID-19 pandemic.
Collapse
Affiliation(s)
- Khaled Safadi
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Joshua M Kruger
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Itay Chowers
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Abraham Solomon
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Radgonde Amer
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Hamzah Aweidah
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Shahar Frenkel
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Hadas Mechoulam
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Irene Anteby
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Hadas Ben Eli
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Itay Lavy
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Tarek Jaouni
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - David Landau
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Liran Tiosano
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Gabriel Greifner
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | - Shay Ofir
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| | | | - Jaime Levy
- Ophthalmology Department, Hadassah Medical Center, Jerusalem, Israel
| |
Collapse
|
15
|
Alm M, Hautala N, Bloigu R, Huhtakangas J. Comparison of optic disc evaluation methods in neurology emergency patients. Acta Neurol Scand 2019; 140:449-451. [PMID: 31518442 DOI: 10.1111/ane.13167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The optic disc examination is critical for the diagnostics of several acute neurological disorders. However, dilation of the pupil is not recommended for neurological patients, which complicates ophthalmoscopy. AIMS OF THE STUDY Present pilot study compared a portable fundus camera to an ophthalmoscope in fundus examinations of neurological emergency patients. To our knowledge, this is the first comparative study of the subject. The fundus photographs were later reviewed with an ophthalmologist. METHODS The study included 60 adults, volunteer neurological emergency patients with either headache, cerebrovascular disorder, or acute confusional state (delirium). Patients' non-mydriatic fundus examination was conducted with an ophthalmoscope and a Smartscope Pro fundus camera. RESULTS Fundus photography succeeded in 56 (93%), partially succeeded in 2 (3%), and failed in 2 (3%) cases compared with ophthalmoscopy that succeeded in 35 (58%), partially succeeded in 14 (23%), and failed in 11 (18%) cases (P < .0005). The researcher and the ophthalmologist agreed in the findings in 54 out of 58 cases (93%). In six cases (7%), the researcher had failed to detect a non-critical ophthalmic finding. CONCLUSIONS The neurological fundus examination by fundus camera seems to be superior to regular ophthalmoscopy in defining the critical optic disc findings in emergency patients.
Collapse
Affiliation(s)
| | - Nina Hautala
- Department of Ophthalmology PEDEGO Research Unit and Medical Research Centre University of Oulu and Oulu University Hospital Oulu Finland
| | - Risto Bloigu
- Medical Informatics Group University of Oulu Oulu Finland
| | | |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW The funduscopic examination can be a technically difficult, and often omitted, portion of the neurologic examination, despite its great potential to influence patient care. RECENT FINDINGS Medical practitioners are often first taught to examine the ocular fundus using a direct ophthalmoscope, however, this skill requires frequent practice. Nonmydriatic tabletop and portable fundus photography and even smartphone-based photography offer alternative and practical means for approaching examination of the ocular fundus. These alternative tools have been shown to be practical in a variety of settings including ambulatory clinics and emergency departments. Decreased retinal microvascular density detected with fundus photography has been linked to accelerated rates of cognitive decline. Research has also found optic disc pallor and retinopathy detected via fundus photography to be more prevalent in patients with recent stroke or transient ischemic attack. SUMMARY Alternative methods of funduscopic examination based on fundus photography have the potential to improve the ease of use, portability, and availability of funduscopy. Recognition of changes in retinal microvasculature has the potential to noninvasively identify patients at the highest risk for cognitive impairment and cerebrovascular disease. However, further research is needed to determine the specific utility of measurements of retinal microvascular changes in clinical care. Innovative funduscopy techniques offer neurologists new approaches to this essential facet of the neurological examination.
Collapse
|