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Wolffsohn JS. 2022 Glenn A. Fry Award lecture: Enhancing clinical assessment for improved ophthalmic management. Optom Vis Sci 2024; 101:12-24. [PMID: 38350054 DOI: 10.1097/opx.0000000000002102] [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: 02/15/2024] Open
Abstract
ABSTRACT Detailed clinical assessment is critical to allow sensitive evaluation of the eye and its management. As technology advances, these assessment techniques can be adapted and refined to improve the detection of pathological changes of ocular tissue and their impact on visual function. Enhancements in optical medical devices including spectacle, contact, and intraocular lenses have allowed for a better understanding of the mechanism and amelioration of presbyopia and myopia control. Advancements in imaging technology have enabled improved quantification of the tear film and ocular surface, informing diagnosis and treatment strategies. Miniaturized electronics, large processing power, and in-built sensors in smartphones and tablets capacitate more portable assessment tools for clinicians, facilitate self-monitoring and treatment compliance, and aid communication with patients. This article gives an overview of how technology has been used in many areas of eye care to improve assessments and treatment and provides a snapshot of some of my studies validating and using technology to inform better evidence-based patient management.
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Zhang S, Phu J, Xu P, Wang H, Kalloniatis M, Zangerl B. The performance and confidence of clinicians in training in the analysis of ophthalmic images within a work-integrated teaching model. Ophthalmic Physiol Opt 2021; 41:768-781. [PMID: 33682940 DOI: 10.1111/opo.12795] [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: 10/23/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE A fundamental clinical skill is the recognition of artefacts within the outputs of advanced imaging modalities. However, current teaching programmes of healthcare practitioners are becoming increasingly challenged to provide practical exposure within an already crowded curriculum. This study evaluates the impact of a novel work-integrated teaching model on the confidence and competence of clinicians in the use of optical coherence tomography (OCT) and the recognition of its artefacts. The outcomes were then used to develop a model to predict performance and guide teaching strategies. METHODS We prospectively evaluated a 6-week clinical placement for final year optometry students within a diagnostic eye clinic in 2018-2020. Participants completed a quiz on the identification of common OCT artefacts and rated their confidence levels on key areas of OCT application using a five-point Likert scale. Both were completed before (pre-rotation) and after (post-rotation) the placement. The cohort was divided into two groups; the first group was used to assess the impact of the placement and derive the prediction model for post-placement performance, which was then validated against the second group. RESULTS A significant improvement in detecting OCT imaging artefacts was seen upon completion of the placement, which was greater in participants with lower entry level performance. Across all OCT artefact subtypes, there was an improvement in detecting segmentation error, delineation error and media opacities. A model predicting post-placement student performance was developed using entry level knowledge base as the key dependent variable. Self-rated confidence improved across all domains of OCT application but was not found to be a direct predictor of actual performance. CONCLUSIONS These results highlight the benefit of a work-integrated learning programme on both academic performance and confidence whilst identifying entry level knowledge base as the key variable predicting improvement. Tailored teaching incorporating entering knowledge is the best predictor of improvement during clinical placements. Integrating clinicians into a work-integrated setting with tailored teaching and comprehensive practical exposure can be an effective method for training future or current healthcare professionals.
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Affiliation(s)
- Sophia Zhang
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Pauline Xu
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Henrietta Wang
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
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Prakash G, Srivastava D. Single session, intrauser repeatability of anterior chamber biometric and corneal pachy-volumetric parameters using a new Scheimpflug+Placido device. JOURNAL OF OPTOMETRY 2016; 9:85-92. [PMID: 26338543 PMCID: PMC4812002 DOI: 10.1016/j.optom.2015.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/23/2015] [Indexed: 05/13/2023]
Abstract
PURPOSE To analyze single session, intrauser reliability of a Scheimpflug device for anterior chamber (AC) and corneal parameters. METHODS In this observational study, 100 normal candidates underwent Scheimpflug analysis with Sirius 3D Rotating Scheimpflug Camera and Topography System (Costruzione Strumenti Oftalmici, Italy). Two scans in dark room conditions were performed by the same experienced user. The candidates were asked to keep both eyes closed for 5min before the scans. Exclusion criteria were previous ocular surgery, corneal scarring and anterior segment/posterior segment anomalies. Only the right eyes were used for the analysis. Both corneal (central, minimum, and apical thickness, volume, horizontal visible iris diameter, and apical curvature) and anterior chamber (volume, depth, angle, horizontal diameter) measurements were evaluated. RESULTS There was no difference in the means of repeated measurements (p>0.05, ANOVA). Intraclass correlations between the measures were high and ranged from 0.995-0.997 for corneal to 0.964-0.997 for anterior chamber (AC) parameters. The precision of repeatability measures (1.96×Sw) was approximately 5μ for the central and minimum corneal thickness, 8μ for the apical corneal thickness, 0.06mm for AC (anterior chamber) depth and less than 2° for the AC angle. CONCLUSIONS Sirius Scheimpflug system has high repeatability for both corneal and AC parameters in normal eyes.
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Affiliation(s)
- Gaurav Prakash
- Department of Cornea and Refractive Surgery, NMC Eye Care, New Medical Center Specialty Hospital, Abu Dhabi, United Arab Emirates.
| | - Dhruv Srivastava
- Department of Cornea and Refractive Surgery, NMC Eye Care, New Medical Center Specialty Hospital, Abu Dhabi, United Arab Emirates
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Is optical coherence tomography an effective device for evaluation of tear film meniscus in patients with acne rosacea? Eye (Lond) 2016; 30:545-52. [PMID: 26768918 DOI: 10.1038/eye.2015.277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 11/13/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To investigate the tear meniscus using Fourier-domain optical coherence tomography (FD-OCT) in patients with acne rosacea and to determine the relationship between tear film break-up tests (TBUT), Schirmer test and FD-OCT values and to compare them with that of healthy controls. METHODS One hundred and four patients with acne rosacea and 104 body mass index age-sex-matched healthy subjects were enrolled in this prospective case-control study. Tear meniscus height (TMH), tear meniscus depth (TMD), and tear meniscus cross-sectional area (TMA) were measured using FD-OCT (RTVue-100); TBUT, Schirmer test and dry eye questionnaire (OSDI) were evaluated. Correlation was assessed using Spearman's correlation coefficient. RESULTS Mean TMH, TMD, TMA, TBUT, and Schirmer test values of acne rosacea patients were significantly lower than and OSDI score significantly higher than those of controls. Tear mensicus values were significantly correlated with OSDI scores, TBUT, and Schirmer test results. The intraobserver intraclass correlation coefficient (ICC) for tear parameters ranged from 0.90 to 0.96 and interobserver ICC ranged from 0.92 to 0.94, which revealed high reproducibility for all measurements parameters both acne rosacea and control subjects. Accuracy of dry eye diagnosis by FD-OCT was 60.4% for TMH, 58.7% for TMD, and 64.8% for TMA. CONCLUSION Tear meniscus measurement with FD-OCT could provide acceptable specificity and sensitivity in diagnosis of dry eye in acne rosacea patients.
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Leng L, Yuan Y, Chen Q, Shen M, Ma Q, Lin B, Zhu D, Qu J, Lu F. Biometry of anterior segment of human eye on both horizontal and vertical meridians during accommodation imaged with extended scan depth optical coherence tomography. PLoS One 2014; 9:e104775. [PMID: 25117696 PMCID: PMC4130593 DOI: 10.1371/journal.pone.0104775] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 07/14/2014] [Indexed: 11/28/2022] Open
Abstract
Purpose To determine the biometry of anterior segment dimensions of the human eye on both horizontal and vertical meridians with extended scan depth optical coherence tomography (OCT) during accommodation. Methods Twenty pre-presbyopic volunteers, aged between 24 and 30, were recruited. The ocular anterior segment of each subject was imaged using an extended scan depth OCT under non- and 3.0 diopters (D) of accommodative demands on both horizontal and vertical meridians. All the images were analyzed to yield the following parameters: pupil diameter (PD), anterior chamber depth (ACD), anterior and posterior surface curvatures of the crystalline lens (ASC and PSC) and the lens thickness (LT). Two consecutive measurements were performed to assess the repeatability and reproducibility of this OCT. They were evaluated by calculating the within-subject standard deviation (SD), a paired t-test, intra-class correlation coefficients (ICC) and the coefficient of repeatability/reproducibility (CoR). Results There were no significant differences between two consecutive measurements on either horizontal or vertical meridians under both two different accommodative statuses (P>0.05). The ICC for all parameters ranged from 0.775 to 0.998, except for the PSC (0.550) on the horizontal meridian under the non-accommodative status. In addition, the CoR for most of the parameters were excellent (0.004% to 4.89%). In all the parameters, only PD and PSC were found different between the horizontal and vertical meridians under both accommodative statuses (P<0.05). PD, ACD, ASC and PSC under accommodative status were significantly smaller than those under the non-accommodative status, except that the PSC at the vertical meridian did not change. In addition, LT was significantly increased when accommodation. Conclusion The extended scan depth OCT successfully measured the dimensions of the anterior eye during accommodation with good repeatability and reproducibility on both horizontal and vertical meridians. The asymmetry of lens posterior surface and oval-shaped pupil were found during accommodation.
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Affiliation(s)
- Lin Leng
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yimin Yuan
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qi Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qingkai Ma
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Beibei Lin
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Dexi Zhu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jia Qu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- * E-mail:
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Tajbakhsh Z, Salouti R, Nowroozzadeh MH, Aghazadeh-Amiri M, Tabatabaee S, Zamani M. Comparison of keratometry measurements using the Pentacam HR, the Orbscan IIz, and the TMS-4 topographer. Ophthalmic Physiol Opt 2012; 32:539-46. [DOI: 10.1111/j.1475-1313.2012.00942.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Zahra Tajbakhsh
- International Branch; Shahid Beheshti University of Medical Sciences; Tehran; Iran
| | - Ramin Salouti
- Poostchi Ophthalmology Research Centre; Shiraz University of Medical Sciences; Shiraz; Iran
| | | | | | - Seyedmehdi Tabatabaee
- Faculty of Rehabilitation; Shahid Beheshti University of Medical Sciences; Tehran; Iran
| | - Mohammad Zamani
- Poostchi Ophthalmology Research Centre; Shiraz University of Medical Sciences; Shiraz; Iran
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Abnormalities of the globe. Clin Radiol 2012; 67:1011-22. [PMID: 22647655 DOI: 10.1016/j.crad.2012.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 03/03/2012] [Accepted: 03/06/2012] [Indexed: 11/20/2022]
Abstract
Although much has been published in the radiology literature on the multitudinous conditions affecting the bony orbit, there has been relatively little on diseases confined to the globe itself. As current cross-sectional imaging techniques evolve, the globes can be visualized in ever greater detail, facilitating the recognition of even fairly subtle disease entities in this region. Indeed, the fact that high-resolution detailed images of this area are achievable without significant time or radiation penalty when evaluating surrounding structures means that incidental disease is not infrequently encountered. As such, common disease entities in this region are of interest to the general radiologist and the diagnosis of globe disease need not be the remit of experienced observers in specialist centres. At our institutions we have recently encountered a number of cases covering a broad spectrum of diagnoses including traumatic, neoplastic, iatrogenic, inflammatory, and infective aetiologies. The purpose of this review is to briefly revise the pertinent anatomical and physiological properties of the globe and to familiarize the reader with the computed tomography (CT) and magnetic resonance imaging (MRI) appearances of a number of these disease states. The collection of abnormalities included is not intended to be exhaustive, merely representative, with the emphasis towards those more commonly encountered.
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Bitton E, Keech A, Simpson T, Jones L. Variability of the Analysis of the Tear Meniscus Height by Optical Coherence Tomography. Optom Vis Sci 2007; 84:903-8. [PMID: 17873764 DOI: 10.1097/opx.0b013e3181560ba8] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Tear meniscus height (TMH) is an established parameter indicative of tear film volume and has recently been determined using an optical coherence tomographer (OCT). The purpose of this study was to evaluate the inter and intra observer variability in TMH assessment using OCT. METHODS Ten subjects (6 M, 4 F; aged 32.5 +/- 6.4 years) had 10 consecutive scans taken of their inferior central tear meniscus (5 scans originating at 90 degrees and 5 origination at 270 degrees) using the OCT2 (Humphrey-Zeiss). Images were analyzed by two observers using custom software on three separate occasions. Following a training session among observers, the images were reevaluated to assess differences in variability. Data were analyzed for differences within and across examiners, for the effect of examiner training and between scan directions. RESULTS The mean TMH and tear volume collapsed across subjects were between 0.24 and 0.25 mm and 25 to 27 nL/mm, respectively. No difference was noted within observers. An interobserver mean volume difference (p = 0.044) was present but was eliminated post training (p = 0.167). Variability was less with scans originating at 90 degrees. CONCLUSIONS The values of the TMH and tear volume are similar to those reported in the literature. Due to the interobserver differences observed, a training session between examiners may prove to be valuable, especially in a large or multicenter study.
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Affiliation(s)
- Etty Bitton
- Ecole d'optométrie, Université de Montréal, Montreal, Quebec, Canada.
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Fayol N, Labbé A, Dupont-Monod S, Dupas B, Baudouin C. [Contribution of confocal microscopy and anterior chamber OCT to the study of corneal endothelial pathologies]. J Fr Ophtalmol 2007; 30:348-56. [PMID: 17486026 DOI: 10.1016/s0181-5512(07)89604-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To describe the appearance of various endothelial diseases with in vivo confocal microscopy and anterior chamber optical coherence tomography (AC OCT). METHODS In this study, ten patients with five different corneal endothelial pathologies were evaluated. Three patients had cornea guttata, three had corneal endothelial precipitates, two had irido-corneo-endothelial (ICE) syndrome, one had endothelial folds, and one had breaks in the Descemet membrane. All patients had bilateral ophthalmologic examinations, in vivo confocal microscopy, and AC OCT analysis. RESULTS In cases of cornea guttata, AC OCT showed a finely embossed line corresponding to the empty intercellular cavities found with in vivo confocal microscopy. Corneal endothelium precipitates had the aspect of round formations suspended with the endothelium. Iris atrophy and irido-corneal synechiae resulting from ICE syndrome were precisely visualized with the AC OCT. CONCLUSION High-resolution images of the anterior segment could be obtained using the AC OCT. Associated with in vivo confocal microscopy, these two new imaging techniques provide a precise evaluation of endothelial pathologies.
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Affiliation(s)
- N Fayol
- Service d'Ophtalmologie III, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, USA
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Wade NJ. Image, eye, and retina (invited review). JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2007; 24:1229-49. [PMID: 17429470 DOI: 10.1364/josaa.24.001229] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Advances in understanding the initial stages of the visual process have been made over the centuries. This heritage will be reviewed with respect to the passage of light through the eye, as well as its gross anatomy and microscopic structure. The links between image formation in the camera and the eye were integrated with the anatomy of the eye in the seventeenth century. They drew attention to the problem of accommodation and to corrections for errors of refraction. Investigations of the structure of the retina were to await the invention of achromatic microscopes in the early nineteenth century. An armory of devices for examining vision and the eye were to follow later in the century. These transformed the study of vision from an observational to an experimental discipline.
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Abstract
PURPOSE OF REVIEW Imaging of the crystalline lens and intraocular lens is becoming increasingly more important to optimize the refractive outcome of cataract surgery, to detect and manage complications and to ascertain advanced intraocular lens performance. This review examines recent advances in anterior segment imaging. RECENT FINDINGS The main techniques used for imaging the anterior segment are slit-lamp biomicroscopy, ultrasound biomicroscopy, scheimpflug imaging, phakometry, optical coherence tomography and magnetic resonance imaging. They have principally been applied to the assessment of intraocular lens centration, tilt, position relative to the iris and movement with ciliary body contraction. SUMMARY Despite the advances in anterior chamber imaging technology, there is still the need for a clinical, high-resolution, true anatomical, noninvasive technique to image behind the peripheral iris.
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Affiliation(s)
- James S Wolffsohn
- Ophthalmic Research Group, Life and Health Sciences, Aston University, Birmingham, UK.
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