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Mendall J, Islam M, Wong K, Sansome S, Sim DA, Bachmann LM, Huemer J, Kang S. Digital Exclusion, Social Deprivation, and Clinical Outcomes of Patients Undergoing Hyperacuity Home Monitoring. Ophthalmol Ther 2024; 13:2759-2769. [PMID: 39181973 PMCID: PMC11408468 DOI: 10.1007/s40123-024-01020-y] [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: 07/02/2024] [Accepted: 08/09/2024] [Indexed: 08/27/2024] Open
Abstract
INTRODUCTION Digital exclusion is a growing challenge when deploying digital patient care pathways and a potential barrier to widespread implementation, especially in the field of smartphone-based self-monitoring of vision. This retrospective case series seeks to examine the characteristics of individuals who adhere to a smartphone home monitoring programme using the Alleye app for retinal disease, with a focus on digital exclusion, social deprivation and clinical outcomes. METHODS We conducted a retrospective analysis of 89 patients with retinal pathologies including diabetic retinopathy and retinal vein occlusions at Moorfields Eye Hospital participating in an Alleye home monitoring programme between April 2020 and November 2022. Postcodes were used to determine the Digital Exclusion Risk Index (DERI) and the Index of Multiple Deprivation (IMD) rebased for London. Clinical information from the electronic patient record and Alleye app usage data were extracted for each patient. Associations between the DERI/IMD, clinical parameters and app use were examined using multivariable regression models. RESULTS Mean DERI was 2.56 (standard deviation [SD] = 0.36), IMD was 6.25 (SD = 2.79), visual acuity (VA) in the better eye at study entry was 83.28 Early Treatment Diabetic Retinopathy Study (ETDRS) letters (SD = 7.92), and mean follow-up was 344.46 days (SD = 260.13). During the observation period, 36% received an intravitreal injection (IVI) and VA fell by at least ten letters in approximately one in four patients. In 87.5% of patients requiring IVI, the use of the app increased. We found no association between clinical parameters and programme adherence for DERI or IMD. CONCLUSIONS We found no association between high digital exclusion risk and high social deprivation with monitoring adherence to smartphone-based self-monitoring of vision, contrary to the currently available evidence. This suggests that smartphone-based self-monitoring of vision is accessible to population groups of varying digital exclusion and social deprivation risk, and can be safely employed to monitor clinical progression.
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Affiliation(s)
| | - Meriam Islam
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Karen Wong
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Stafford Sansome
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | - Dawn A Sim
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
| | | | - Josef Huemer
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK
- Department of Ophthalmology and Optometry, Kepler University Hospital, Linz, Austria
| | - Swan Kang
- University College London, London, UK.
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, UK.
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Suwal B, Khadka D, Shrestha A, Suwal R, Khatri B. Quantification of Metamorphopsia in Resolved Idiopathic Central Serous Chorioretinopathy: An Analysis Using M-CHARTS, Amsler Grid, and Optical Coherence Tomography. Clin Ophthalmol 2024; 18:937-942. [PMID: 38562644 PMCID: PMC10982064 DOI: 10.2147/opth.s456556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose To quantify metamorphopsia in patients with resolved idiopathic Central Serous Chorioretinopathy (CSCR) using M-CHARTS and compare the results with the traditional Amsler grid and optical coherence tomography (OCT). Patients and Methods For the purpose of this study, all consecutive cases of patients with resolved CSCR were evaluated for metamorphopsia (using the standard Amsler grid and M-CHARTS) and spectral domain OCT. The OCT images were analyzed for the following five parameters: central macular thickness, pigment epithelial detachment, retinal pigment epithelial bumps, discontinuation in the inner segment/outer segment junction or the external limiting membrane, fibrinous exudates in the subretinal space, and hyperreflective dots in the intraretinal and/or subretinal layer. Binary logistic regression was used to find the association between metamorphopsia and foveal morphology. Cohen's Kappa was used to determine the agreement between the M-CHARTS and Amsler grid for diagnosing metamorphopsia. The sensitivity, specificity, and accuracy in the diagnosis of metamorphopsia were calculated against the Amsler grid. Results Of 41 eyes, Amsler Grid detected metamorphopsia in 39.02%, and M-CHARTS detected metamorphopsia in 53.66%. The agreement rate of detection between the two tests was moderate (Kappa=0.52). M-CHARTS had a sensitivity of 87.50%, a specificity of 68.00%, a positive predictive value of 63.64%; and a negative predictive value of 89.47% for the diagnosis of metamorphopsia compared to the Amsler grid. The presence of PED in OCT was significantly associated with metamorphopsia. Conclusion M-CHARTS can be a useful ancillary test to detect and quantify metamorphopsia even after fluid resolution in CSCR. Structural changes in macular morphology as observed with OCT can predict the likelihood of metamorphopsia.
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Affiliation(s)
- Barsha Suwal
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Deepak Khadka
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Arjun Shrestha
- Department of Ophthalmology, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Rinkal Suwal
- Department of Optometry, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
| | - Bijay Khatri
- Academic and Research Department, BP Eye Foundation, Hospital for Children, Eye, ENT, and Rehabilitation Services, Bhaktapur, Nepal
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Imai A, Fukuyama H, Gomi F. Comparison of the detection of metamorphopsia between Amsler chart and M-CHARTS. Graefes Arch Clin Exp Ophthalmol 2023; 261:1503-1504. [PMID: 36472689 DOI: 10.1007/s00417-022-05930-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 09/06/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ayame Imai
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-Cho, Nishinomiya, 663-8501, Japan
| | - Hisashi Fukuyama
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-Cho, Nishinomiya, 663-8501, Japan.
| | - Fumi Gomi
- Department of Ophthalmology, Hyogo College of Medicine, 1-1 Mukogawa-Cho, Nishinomiya, 663-8501, Japan
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Wu CT, Lin TY, Lin CJ, Hwang DK. The future application of artificial intelligence and telemedicine in the retina: A perspective. Taiwan J Ophthalmol 2023; 13:133-141. [PMID: 37484624 PMCID: PMC10361422 DOI: 10.4103/tjo.tjo-d-23-00028] [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: 03/05/2023] [Accepted: 04/02/2023] [Indexed: 07/25/2023] Open
Abstract
The development of artificial intelligence (AI) and deep learning provided precise image recognition and classification in the medical field. Ophthalmology is an exceptional department to translate AI applications since noninvasive imaging is routinely used for the diagnosis and monitoring. In recent years, AI-based image interpretation of optical coherence tomography and fundus photograph in retinal diseases has been extended to diabetic retinopathy, age-related macular degeneration, and retinopathy of prematurity. The rapid development of portable ocular monitoring devices coupled with AI-informed interpretations allows possible home monitoring or remote monitoring of retinal diseases and patients to gain autonomy and responsibility for their conditions. This review discusses the current research and application of AI, telemedicine, and home monitoring devices on retinal disease. Furthermore, we propose a future model of how AI and digital technology could be implemented in retinal diseases.
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Affiliation(s)
- Chu-Ting Wu
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Ting-Yi Lin
- Doctoral Degree Program of Translational Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, Taiwan
| | - Cheng-Jun Lin
- Department of Biological Science and Technology, Institute of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Chen E, Mills M, Gallagher T, Ianchulev S, Habash R, Gentile RC. Remote patient monitoring of central retinal function with MACUSTAT ®: A multi-modal macular function scan. Digit Health 2022; 8:20552076221132105. [PMID: 36276185 PMCID: PMC9580074 DOI: 10.1177/20552076221132105] [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: 04/20/2022] [Accepted: 09/25/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION There is significant unmet need for patient-centric remote monitoring of visual function for chronic retinal diseases, as demonstrated by the COVID-19 pandemic. The Macustat® central retinal function scan is a novel cloud-based digital health application for remote monitoring. The aim of this study is to assess the efficacy of the Macustat® compared to traditional in-office retinal evaluations. MATERIALS AND METHODS Patients with underlying macular pathology underwent office-based retinal and visual acuity examinations and OCT macula imaging followed by remote tele-monitoring assessment with the Macustat. Central visual function was assessed with the multi-modal Macustat test using dynamic virtual Amsler grid testing, hyperacuity perimetry and visual acuity testing. The results were compared to the findings of the in-office comprehensive retina exam and OCT evaluation. RESULTS The foveal acuity potential registered with the Macustat test showed high correlation with the office Snellen acuity potential 96% of eyes registered Macustat acuity within 0.2 LogMAR of office acuity measurement. In Wet AMD eyes with CNV pathology documented on OCT, the Macustat foveal function scan showed a corresponding abnormality in 89% of any CNV eyes and 100% of all visually significant CNV. In normal eyes without any visually significant edema or CNV, more than 92% showed corresponding normal retinal function scan. CONCLUSION The Macustat demonstrates high concordance with clinical findings using traditional diagnostic devices. Home monitoring with the Macustat® may offer complementary clinical utility as a telehealth tool for the assessment of visual acuity and macular function in patients at high risk for macular disease.
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Affiliation(s)
| | | | | | - Sean Ianchulev
- Ophthalmology, New York Eye and Ear of Mount Sinai, New York, NY, USA,Sean Ianchulev, Ophthalmology, New York Eye and Ear of Mount Sinai, Icahn School of Medicine, 310 E 14th Street Suite 319 South, New York, NY 10003, USA.
| | | | - Ronald C Gentile
- Ophthalmology, New York Eye and Ear of Mount Sinai, New York, NY, USA
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Sugimoto M, Wakamatsu Y, Miyata R, Kato K, Matsubara H, Kondo M. Effectiveness of microperimetry in evaluating anti-vascular endothelial growth factor therapy for diabetic macular edema patients with relatively good vision: A retrospective observational study. Medicine (Baltimore) 2021; 100:e28404. [PMID: 34941181 PMCID: PMC8702257 DOI: 10.1097/md.0000000000028404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/02/2021] [Indexed: 11/25/2022] Open
Abstract
No studies have evaluated the retinal sensitivity (RS) for diabetic macular edema (DME) patients with good vision. Therefore, this study aimed to determine the effectiveness of microperimetry in evaluating the effectiveness of anti-vascular endothelial growth factor (anti-VEGF) treatment for DME patients with relatively good vision.Twenty-seven eyes of 27 patients (mean age, 61.3 ± 11.2 years) with DME and decimal best-corrected visual acuity (BCVA) ≥0.6 were studied. All patients received 3 consecutive monthly injections of intravitreal anti-VEGF agents. The BCVA, central subfield macular thickness (CMT), and RS were evaluated by microperimetry (MAIA) within the 10 degree of the foveal center. To determine significant differences between the values, we used paired t tests.Patients were evaluated at baseline and 4 weeks after the third injection. The BCVA improved significantly from 0.18 ± 0.06 logarithm of the minimum angle of resolution (logMAR) units to 0.13 ± 0.13 logMAR units (P = .002; paired t test). The CMT decreased significantly from 464.3 ± 91.8 μm to 393.4 ± 129.0 μm (P = .005), and the RS also improved significantly from 21.8 ± 3.1 dB to 24.1 ± 2.8 dB at 4 weeks after treatment (P = .006). Among the patients with a decimal BCVA of 0.7 or better at baseline, there was no significant improvement in the BCVA (P = .28). However, the CMT decreased significantly from 479.5 ± 79.1 μm to 394.0 ± 99.8 μm at 4 weeks after treatment (P = .007). The RS also improved significantly from 22.0 ± 2.4 dB to 24.0 ± 3.1 dB at 4 weeks after treatment (P = .004).Measuring RS by microperimetry is a good option for evaluating the effectiveness of anti-VEGF treatment for DME patients with a relatively good BCVA.
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Metamorphopsia and Morphological Changes in the Macula after Scleral Buckling Surgery for Macula-Off Rhegmatogenous Retinal Detachment. J Ophthalmol 2021; 2021:5525049. [PMID: 34258046 PMCID: PMC8253631 DOI: 10.1155/2021/5525049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/19/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To observe the changes in metamorphopsia after scleral buckling (SB) surgery for macula-off rhegmatogenous retinal detachment (RRD) and its association with morphological changes in the macula. Methods This prospective study included 20 eyes of 20 patients. Before surgery and 1, 3, 6, and 12 months after surgery, metamorphopsia measured by M-charts and best-corrected visual acuity (BCVA) and macular microstructures assessed using optical coherence tomography were recorded. Results Both the vertical and horizontal M-scores improved significantly after SB surgery. BCVA also improved gradually. The mean M-score in the eyes with a continuous external limiting membrane (ELM) was smaller than that in the eyes with a disrupted ELM (P=0.008). Preoperative and postoperative BCVA did not correlate with the mean M-score at any time point. The other studied parameters, namely, the duration of RRD, the height of retinal detachment, central foveal thickness, inner nuclear layer thickness, and continuation of the ellipsoid zone, were also not relevant. Conclusions The continuation of the ELM may be a critical factor in determining the severity of metamorphopsia after SB surgery for macula-off RRD.
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Diabetic retinopathy and diabetic macular oedema pathways and management: UK Consensus Working Group. Eye (Lond) 2021; 34:1-51. [PMID: 32504038 DOI: 10.1038/s41433-020-0961-6] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The management of diabetic retinopathy (DR) has evolved considerably over the past decade, with the availability of new technologies (diagnostic and therapeutic). As such, the existing Royal College of Ophthalmologists DR Guidelines (2013) are outdated, and to the best of our knowledge are not under revision at present. Furthermore, there are no other UK guidelines covering all available treatments, and there seems to be significant variation around the UK in the management of diabetic macular oedema (DMO). This manuscript provides a summary of reviews the pathogenesis of DR and DMO, including role of vascular endothelial growth factor (VEGF) and non-VEGF cytokines, clinical grading/classification of DMO vis a vis current terminology (of centre-involving [CI-DMO], or non-centre involving [nCI-DMO], systemic risks and their management). The excellent UK DR Screening (DRS) service has continued to evolve and remains world-leading. However, challenges remain, as there are significant variations in equipment used, and reproducible standards of DMO screening nationally. The interphase between DRS and the hospital eye service can only be strengthened with further improvements. The role of modern technology including optical coherence tomography (OCT) and wide-field imaging, and working practices including virtual clinics and their potential in increasing clinic capacity and improving patient experiences and outcomes are discussed. Similarly, potential roles of home monitoring in diabetic eyes in the future are explored. The role of pharmacological (intravitreal injections [IVT] of anti-VEGFs and steroids) and laser therapies are summarised. Generally, IVT anti-VEGF are offered as first line pharmacologic therapy. As requirements of diabetic patients in particular patient groups may vary, including pregnant women, children, and persons with learning difficulties, it is important that DR management is personalised in such particular patient groups. First choice therapy needs to be individualised in these cases and may be intravitreal steroids rather than the standard choice of anti-VEGF agents. Some of these, but not all, are discussed in this document.
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Faes L, Bachmann LM, Sim DA. Home monitoring as a useful extension of modern tele-ophthalmology. Eye (Lond) 2020; 34:1950-1953. [PMID: 32405047 PMCID: PMC7784909 DOI: 10.1038/s41433-020-0964-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/01/2020] [Accepted: 05/01/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Livia Faes
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.,Cantonal Hospital Lucerne, Lucerne, Switzerland
| | | | - Dawn A Sim
- Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK.
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Nakano E, Ota T, Jingami Y, Nakata I, Hayashi H, Yamashiro K. Correlation between metamorphopsia and disorganization of the retinal inner layers in eyes with diabetic macular edema. Graefes Arch Clin Exp Ophthalmol 2019; 257:1873-1878. [PMID: 31227899 DOI: 10.1007/s00417-019-04393-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 05/08/2019] [Accepted: 06/10/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To investigate factors associated with the severity of metamorphopsia secondary to diabetic macular edema (ME) by evaluating optical coherence tomography (OCT) parameters including disorganization of the retinal inner layers (DRIL). METHODS We retrospectively reviewed medical records of 37 eyes of 37 consecutive patients with diabetic ME or resolved diabetic ME, who underwent spectral-domain OCT examination and metamorphopsia assessment with M-CHARTS on the same day between November 2017 and March 2018. Age, sex, visual acuity, lens status, treatment history, and factors analyzed on OCT examination including DRIL length were evaluated in association with M-CHARTS scores. RESULTS Metamorphopsia was detected in 20 eyes (54%). The patients with metamorphopsia were relatively older than those without it (P = 0.060), and DRIL length was relatively longer in eyes with metamorphopsia (P = 0.065), while visual acuity was significantly better in eyes without metamorphopsia (P = 0.048). In correlation analyses to the severity of metamorphopsia, the DRIL length was the only OCT parameter associated with the M-CHARTS score (P = 0.035), while age, visual acuity, and ME were not significantly associated with the severity of metamorphopsia (P = 0.051, 0.060, and 0.344, respectively). CONCLUSION The DRIL length was significantly associated with the severity of metamorphopsia secondary to diabetic ME. The inner retinal layer plays a key role in the development of metamorphopsia in eyes with diabetic ME. Metamorphopsia should be carefully considered when treating diabetic ME since its severity has been found to be independent of visual acuity and ME status.
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Affiliation(s)
- Eri Nakano
- Department of Ophthalmology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Toru Ota
- Department of Ophthalmology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Yoko Jingami
- Department of Ophthalmology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Isao Nakata
- Department of Ophthalmology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Hisako Hayashi
- Department of Ophthalmology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology, Otsu Red Cross Hospital, 1-1-35 Nagara, Otsu, Shiga, 520-8511, Japan.
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