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Okonkwo ON, Adenuga OO, Nkanga D, Ovienria W, Ibanga A, Agweye CT, Oyekunle I, Akanbi T. Prevalence and systemic associations of retinal vascular occlusions in Sub-Saharan Africa. Ann Afr Med 2023; 22:279-285. [PMID: 37417014 PMCID: PMC10445699 DOI: 10.4103/aam.aam_44_22] [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: 03/08/2022] [Revised: 09/03/2022] [Accepted: 01/02/2023] [Indexed: 07/08/2023] Open
Abstract
Background Retinal vascular occlusions are a common cause of visual impairment. Studies on retinal vascular occlusions in sub-Saharan Africa (SSA) have primarily been retrospective and on retinal vein occlusion (RVO) only. The aim of this study, therefore, was to determine the prevalence and pattern of retinal vascular occlusions and their systemic associations in SSA. Materials and Methods This was a hospital-based, cross-sectional study involving all new patients presenting at the general ophthalmic and specialty retina clinics in four hospitals in Nigeria over a 1 year period. All the patients underwent a comprehensive eye examination. The demographic and clinical data of patients with retinal vascular occlusions were entered into an excel sheet and analyzed using the Statistical Package for the Social Sciences (SPSS) software version 22.0. Statistical significance was indicated by P < 0.05. Results A total of 8614 new patients were seen, and a diagnosis of retinal vascular occlusion was made in 90 eyes of 81 patients giving a disease prevalence of 0.9%. Eighty-one eyes of 72 (88.9%) patients had RVO, while 9 eyes of 9 (11.1%) patients had retinal artery occlusion (RAO). The mean age of patients with RVO and RAO was 59.5 years and 52.4 years, respectively. Increasing age, hypertension, and diabetes were the significant associations with retinal vascular occlusion with P < 0.0001. Conclusion Retinal vascular occlusions are an increasing cause of retinal disease in SSA and tend to occur at an earlier age. They are associated with hypertension, diabetes, and increasing age. Further studies will, however, be required to establish the demographic and clinical profile of patients with RAO in the region.
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Affiliation(s)
| | - Olukorede O. Adenuga
- Department of Ophthalmology, Jos University Teaching Hospital, Jos, Plateau, Nigeria
| | - Dennis Nkanga
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Wilson Ovienria
- Department of Ophthalmology, Irrua Specialist Hospital, Edo, Nigeria
| | - Affiong Ibanga
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Chineze Thelma Agweye
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - Idris Oyekunle
- Department of Retina, Eye Foundation Hospital, Lagos, Nigeria
| | - Toyin Akanbi
- Department of Retina, Eye Foundation Hospital, Lagos, Nigeria
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Xiao Y, Hu Y, Quan W, Yang Y, Lai W, Wang X, Zhang X, Zhang B, Wu Y, Wu Q, Liu B, Zeng X, Lin Z, Fang Y, Hu Y, Feng S, Yuan L, Cai H, Li T, Lin H, Yu H. Development and validation of a deep learning system to classify aetiology and predict anatomical outcomes of macular hole. Br J Ophthalmol 2023; 107:109-115. [PMID: 34348922 PMCID: PMC9763201 DOI: 10.1136/bjophthalmol-2021-318844] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/23/2021] [Indexed: 11/03/2022]
Abstract
AIMS To develop a deep learning (DL) model for automatic classification of macular hole (MH) aetiology (idiopathic or secondary), and a multimodal deep fusion network (MDFN) model for reliable prediction of MH status (closed or open) at 1 month after vitrectomy and internal limiting membrane peeling (VILMP). METHODS In this multicentre retrospective cohort study, a total of 330 MH eyes with 1082 optical coherence tomography (OCT) images and 3300 clinical data enrolled from four ophthalmic centres were used to train, validate and externally test the DL and MDFN models. 266 eyes from three centres were randomly split by eye-level into a training set (80%) and a validation set (20%). In the external testing dataset, 64 eyes were included from the remaining centre. All eyes underwent macular OCT scanning at baseline and 1 month after VILMP. The area under the receiver operated characteristic curve (AUC), accuracy, specificity and sensitivity were used to evaluate the performance of the models. RESULTS In the external testing set, the AUC, accuracy, specificity and sensitivity of the MH aetiology classification model were 0.965, 0.950, 0.870 and 0.938, respectively; the AUC, accuracy, specificity and sensitivity of the postoperative MH status prediction model were 0.904, 0.825, 0.977 and 0.766, respectively; the AUC, accuracy, specificity and sensitivity of the postoperative idiopathic MH status prediction model were 0.947, 0.875, 0.815 and 0.979, respectively. CONCLUSION Our DL-based models can accurately classify the MH aetiology and predict the MH status after VILMP. These models would help ophthalmologists in diagnosis and surgical planning of MH.
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Affiliation(s)
- Yu Xiao
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yijun Hu
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China,Aier School of Ophthalmology, Central South University, Changsha, China
| | - Wuxiu Quan
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Weiyi Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Xun Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Bin Zhang
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Yuqing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Qiaowei Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Baoyi Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaomin Zeng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhanjie Lin
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ying Fang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu Hu
- Department of Opthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Songfu Feng
- Department of Ophthalmology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ling Yuan
- Department of Opthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongmin Cai
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Tao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic CenterSun, Yat-sen University, Guangzhou, China .,Center of Precision Medicine, Sun Yat-sen University, Guangzhou, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China .,Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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3
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De Silva I, Thomas MG, Shirodkar AL, Kuht HJ, Ku JY, Chaturvedi R, Beer F, Patel R, Rana-Rahman R, Anderson S, Dickerson P, Walsh F, While B, Clarke L, Siriwardena D, Dhawahir-Scala F, Buchan J, Verma S. Patterns of attendances to the hospital emergency eye care service: a multicentre study in England. Eye (Lond) 2022; 36:2304-2311. [PMID: 34845355 PMCID: PMC8629695 DOI: 10.1038/s41433-021-01849-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/09/2021] [Accepted: 11/08/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/OBJECTIVES To characterise the patterns of presentation and diagnostic frequencies in Hospital Emergency Eye Care Services (HEECS) across 13 hospitals in England. METHODS Retrospective, cross-sectional, observational multi-centre (n = 13) study to assess HEECS attendances over a 28-day study period. Data derived included: number of consecutive attendances, patient demographics and diagnoses. Age and gender variations, the impact of day of the week on attendance patterns, diagnostic frequencies and estimates of the annual incidence and attendance rates were evaluated. RESULTS A total of 17,667 patient (mean ± standard deviation age = 49.6 ± 21.8 years) attendances were identified with an estimated HEECS annual new attendance rate of 31.0 per 1,000 population. Significantly more females (53%) than males (47%) attended HEECS (p < 0.001). Female attendances were 13% higher in those ≥50 years of age. Weekends were associated with a significant reduction in attendances compared to weekdays (χ2 = 6.94, p < 0.001). Among weekdays, Mondays and Fridays were associated with significantly higher attendances compared with midweek (χ2 = 2.20, p = 0.032). Presenting pathologies involving the external eye, cornea and conjunctiva accounted for 28.6% of the caseload. CONCLUSION This is the largest multicentre study assessing attendance patterns in HEECS in England. We have, for the first time, observed a "weekend effect" in relation to attendance to HEECS. Differences in health-seeking behaviour and lack of awareness of HEECS weekend services may be partly attributed to the differences observed. Our findings, along with the type of presentations, have the potential to guide commissioners with future planning of HEECS.
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Affiliation(s)
- Ian De Silva
- Department of Ophthalmology, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
| | - Mervyn G Thomas
- Department of Ophthalmology, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, PO Box 65, Leicester, LE2 7LX, UK
| | - Amy-Lee Shirodkar
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Helen J Kuht
- Department of Ophthalmology, University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, LE1 5WW, UK
- The University of Leicester Ulverscroft Eye Unit, Department of Neuroscience, Psychology and Behaviour, University of Leicester, PO Box 65, Leicester, LE2 7LX, UK
| | - Jae Yee Ku
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
- Department of Eye and Vision Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L7 8TX, UK
| | - Ritu Chaturvedi
- Manchester Royal Eye Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - Freddy Beer
- Ophthalmology Department, Queen Alexandra Hospital, Southwick Hill Road, Portsmouth, PO6 3LY, UK
| | - Radhika Patel
- The Victoria Eye Unit, The County Hospital, Union Walk, Hereford, HR1 2ER, UK
| | - Romeela Rana-Rahman
- Eye Department, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Sarah Anderson
- Department of Ophthalmology, York Teaching Hospitals NHS Foundation Trust, Wigginton Road, York, YO31 8HE, UK
| | - Polly Dickerson
- Department of Ophthalmology, Scarborough Hospital, Woodlands Drive, Scarborough, YO12 6QL, UK
| | - Francine Walsh
- Ophthalmology Department, Royal Bolton Hospital, Minerva Road, Bolton, BL4 0JR, UK
| | - Ben While
- The Victoria Eye Unit, The County Hospital, Union Walk, Hereford, HR1 2ER, UK
| | - Lucy Clarke
- Eye Department, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, UK
| | - Dilani Siriwardena
- Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | | | - John Buchan
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- The Leeds Centre for Ophthalmology, St. James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - Seema Verma
- Eye Department, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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Acharya S, Kharel Sitaula R, Karki P, Mishra SK, Dahal HN, Poudel A. Does outer retinal layer thickness correlate with the central visual field indices in early dry age-related macular degeneration? Taiwan J Ophthalmol 2022; 12:437-443. [PMID: 36660124 PMCID: PMC9843572 DOI: 10.4103/tjo.tjo_29_22] [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: 02/17/2022] [Accepted: 05/11/2022] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Age-related macular degeneration (ARMD) is the leading cause of irreversible blindness worldwide and Nepal is one among them. We aimed to determine the relationship between outer retinal layer thickness parameters with central visual field indices in early dry ARMD cases among Nepalese population. MATERIALS AND METHODS The subjects for this descriptive, cross-sectional study comprised 40 patients with early dry ARMD from the ophthalmology department of a tertiary level hospital of Nepal. The retinal layer thickness was measured with spectral-domain optical coherence tomography (SD-OCT), and the visual field indices were assessed using the 10-2 protocol of Humphrey visual field analyzer (HFA). Thus, the retinal layer structures correlated with visual field indices among our population. RESULTS Among our early dry ARMD population, the foveal threshold (FT) was found to be significantly correlated with retinal pigment epithelium (RPE) elevation (P < 0.01, r = -0.541), outer segment (OS) length (P = 0.02, r = 0.465), and inner segment ellipsoid (ISe) band disruption (P = 0.01, r = -0.499), but not with presence of hyperreflective foci (P = 0.464), RPE thickness (P = 0.612), and central macular thickness (P = 0.214). However, no significant correlation between mean deviation and pattern standard deviation of visual field with retinal layer thickness parameters was identified. CONCLUSION In early dry ARMD, a reduced FT is significantly correlated with the integrity of the ISe band, thinning of OS length, and drusen-associated RPE elevation. The results highlight the utility of both SD-OCT retinal layer measurement and central visual field testing by HFA in ARMD to monitor the progression of the disease.
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Affiliation(s)
- Sarmila Acharya
- Department of Ophthalmology, B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Bagmati, Nepal
| | - R Kharel Sitaula
- Department of Ophthalmology, B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Bagmati, Nepal,Address for correspondence: Dr. Kharel Sitaula R, Department of Ophthalmology, B. P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Kathmandu, Bagmati, Nepal. E-mail:
| | - Pratap Karki
- Department of Ophthalmology, B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Bagmati, Nepal
| | - Sanjeeb Kumar Mishra
- Department of Ophthalmology, B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Bagmati, Nepal
| | - Hira Nath Dahal
- Department of Ophthalmology, B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Bagmati, Nepal
| | - Amit Poudel
- Department of Ophthalmology, B.P. Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Kathmandu, Bagmati, Nepal
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Abebe D, Tsegaw A. Pattern of vitreo-retinal diseases at University of Gondar tertiary eye care and training center, North-West Ethiopia. PLoS One 2022; 17:e0267425. [PMID: 35446916 PMCID: PMC9022795 DOI: 10.1371/journal.pone.0267425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/03/2021] [Indexed: 11/18/2022] Open
Abstract
Objective
Vitreoretinal diseases are common causes of ocular morbidities and blindness. Data on the spectrum of vitreoretinal diseases needs to be studied and known in order to establish appropriate vitreoretinal care setups. The aim of this study was to determine the patterns of vitreoretinal diseases among patients who visited the vitreoretina clinic of University of Gondar Tertiary Eye Care and Training Center, NW Ethiopia (UoG-TECTC).
Methodology
A hospital based cross sectional study was conducted from October/2017-September/2018. All patients who visited the vitreoretinal clinic for the first time during the study period were studied. Data were collected with standardized data extraction format entered into SPSS statistical package Version 20 and analyzed.
Result
A total of 739 new patients who visited the vitreoretinal clinic were included in the study. The mean age was 50.26 +/- 19 years. The age group between 21–60 years accounted for 59.7% of study patients. Male’s accounted for 63.1% and 58.7% of the participants were from urban areas. Bilateral disease was diagnosed in 504 (68.2%) of patients and 220 (29.7%) were bilaterally blind at presentation. Three hundred eighty nine (52.6%) of them had duration of illness six months and above.
Diabetic Retinopathy (DR), Age Related Macular Degeneration (AMD) and Rhegmatoginous Retinal Detachment (RRD) were the top three retinal diseases accounting for 21.3%(196), 17.3% (128) and 12.4% (92) of diagnoses respectively. Systemic comorbidities were found in 44% (325) of the patients with diabetes mellitus, hypertension and hyperlipidemia being the commonest, occurring in 27.8%, 6.3% and 2.8% of study patients respectively. Cataract was the commonest ocular comorbidity seen in 33.5% of study participants.
Conclusion
Vitreoretinal diseases affected a significant number of patients presented to our center and most of the study patients presented late with significant vision loss and blindness. Males were affected more than females and the age group between 21–60 years accounted nearly two-third of study patients. This is the working age group suffering from vision loss from vitreoretinal diseases. DR, AMD and RRD were the commonest retinal pathologies accounting for nearly half of the vitreoretinal diseases and these conditions are treatable either surgically or medically. However, available facilities for the management of these diseases are not adequate at the center. Strengthening the vitreoretinal services of UoG-TECTC with relevant equipment is recommended.
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Affiliation(s)
- Dagmawi Abebe
- Department of Ophthalmology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asamere Tsegaw
- Department of Ophthalmology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
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Im JHB, Jin YP, Chow R, Yan P. Prevalence of diabetic macular edema based on optical coherence tomography in people with diabetes: A systematic review and meta-analysis. Surv Ophthalmol 2022; 67:1244-1251. [PMID: 35093404 DOI: 10.1016/j.survophthal.2022.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/01/2022]
Abstract
Diabetic macular edema (DME) is a leading cause of vision loss among people with diabetes. Optical coherence tomography (OCT) allows for accurate assessment and early detection of DME. Meta-analyses on DME prevalence diagnosed with OCT are lacking. We performed a meta-analysis to assess the global prevalence of OCT-diagnosed DME. We searched five electronic databases (EMBASE, CINAHL, Web of Science, Scopus, and MEDLINE) on May 29, 2020 and updated the search on March 19 and June 22, 2021. The quality of retrieved studies was evaluated using the Joanna Briggs Institute Checklist for Prevalence Studies. A random-effects model was used to pool prevalence estimates. Countries were classified into low-to-middle-income and high-income countries using World Bank data for subgroup analyses. Seven studies were included in this meta-analysis. The pooled prevalence of DME was 5.47% (95% CI: 3.66%-7.62%) overall, 5.81% (95% CI: 0.07%-18.51%) in low-to-middle-income countries and 5.14% (95% CI: 3.44%-7.15%) in high-income countries. We reported approximately 5.5% of people with diabetes have DME, with a statistically non-significantly lower prevalence in high-income countries versus low-to-middle-income countries. Given the global pandemic of diabetes, there is a need to inform physicians and educate people with diabetes regarding early detection and treatment of DME using OCT.
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Affiliation(s)
- James H B Im
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ya-Ping Jin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada
| | - Ronald Chow
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Peng Yan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Kensington Vision and Research Centre, Toronto, Canada.
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Macular Hole Detection Using a New Hybrid Method: Using Multilevel Thresholding and Derivation on Optical Coherence Tomographic Images. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2021:6904217. [PMID: 34976042 PMCID: PMC8716210 DOI: 10.1155/2021/6904217] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/08/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022]
Abstract
Optical coherence tomography (OCT) is a noninvasive imaging test. OCT imaging is analogous to ultrasound imaging, except that it uses light instead of sound. In this type of image, microscopic quality intratissue images are provided. In addition, fast and direct imaging of tissue morphology and reproducibility of results are the advantages of this imaging. Macular holes are a common eye disease that leads to visual impairment. The macular perforation is a rupture in the central part of the retina that, if left untreated, can lead to vision loss. A novel method for detecting macular holes using OCT images based on multilevel thresholding and derivation is proposed in this paper. This is a multistep method, which consists of segmentation, feature extraction, and feature selection. A combination of thresholding and derivation is used to diagnose the macular hole. After feature extraction, the features with useful information are selected and finally the output image of the macular hole is obtained. An open-access data set of 200 images with the size of 224 × 224 pixels from Sankara Nethralaya (SN) Eye Hospital, Chennai, India, is used in the experiments. Experimental results show better-diagnosing results than some recent diagnosing methods.
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8
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Owusu-Afriyie B, Baimur I, Gende T, Baia T. Prevalence of Risk Factors of Retinal Diseases among Patients in Madang Province, Papua New Guinea. Int J Clin Pract 2022; 2022:6120908. [PMID: 36120664 PMCID: PMC9467746 DOI: 10.1155/2022/6120908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/19/2022] [Accepted: 08/14/2022] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To explore the prevalence of risk factors of retinal diseases among patients seeking services from Madang Provincial Hospital Eye Clinic in Papua New Guinea. MATERIALS AND METHODS A hospital-based retrospective study was conducted at the only eye clinic serving the entire Madang province of Papua New Guinea. Purposive sampling was used to obtain data from patients' record cards at the eye clinic from January to June 2021. The data collected included gender, age, presenting visual acuity, blood pressure, blood sugar level, body mass index, smoking habits, and history of cataract surgery. The data was analyzed using the International Business Machines Corporation's Statistical Package for Social Sciences version 21. A p-value of <0.05 was considered statistically significant. RESULTS Two hundred and fifty-five (255) patients went through diabetes and hypertension screening during the period of the study (January to June 2021). The mean age of the patients was 53.14 ± 11.20 years and there were more males (56.86%) than females. Nearly half of the patients (43.6%) were either visually impaired or blind. More than half (52.6%) had diabetes mellitus. Majority of the patients (73.3%) were hypertensive and more than half (57.0%) of the patients had unhealthy body mass index (BMI <18.525 kg/m2 or > 25 kg/m2). Overweight was significantly associated with hypertension (p < 0.001) and diabetes mellitus (p < 0.001). A few of them were smokers or had a history of cataract surgery (13.7% and 2.0%, respectively). CONCLUSION There is a high prevalence of diabetes, hypertension, and overweight among ophthalmic patients in Madang. It is important that measures are put in place to eliminate barriers to health care and to strengthen eye care services in Papua New Guinea.
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Affiliation(s)
- Bismark Owusu-Afriyie
- Eye Care Programme, Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
- Fred Hollows Foundation PNG Inc, Madang, Papua New Guinea
| | - Isabelle Baimur
- Eye Care Programme, Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
| | - Theresa Gende
- Eye Care Programme, Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
- Fred Hollows Foundation PNG Inc, Madang, Papua New Guinea
| | - Thomas Baia
- Eye Care Programme, Faculty of Medicine and Health Sciences, Divine Word University, Madang, Papua New Guinea
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9
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Xiao Y, Hu Y, Quan W, Zhang B, Wu Y, Wu Q, Liu B, Zeng X, Lin Z, Fang Y, Hu Y, Feng S, Yuan L, Cai H, Yu H, Li T. Machine learning-based prediction of anatomical outcome after idiopathic macular hole surgery. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:830. [PMID: 34164464 PMCID: PMC8184483 DOI: 10.21037/atm-20-8065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background To develop a machine learning (ML) model for the prediction of the idiopathic macular hole (IMH) status at 1 month after vitrectomy and internal limiting membrane peeling (VILMP) surgery. Methods A total of 288 IMH eyes from four ophthalmic centers were enrolled. All eyes underwent optical coherence tomography (OCT) examinations upon admission and one month after VILMP. First, 1,792 preoperative macular OCT parameters and 768 clinical variables of 256 eyes from two ophthalmic centers were used to train and internally validate ML models. Second, 224 preoperative macular OCT parameters and 96 clinical variables of 32 eyes from the other two centers were utilized for external validation. To fulfill the purpose of predicting postoperative IMH status (i.e., closed or open), five ML algorithms were trained and internally validated by the ten-fold cross-validation method, while the best-performing algorithm was further tested by an external validation set. Results In the internal validation, the mean area under the receiver operating characteristic curves (AUCs) of the five ML algorithms were 0.882-0.951. The AUC, accuracy, sensitivity, and specificity of the best-performing algorithm (i.e., random forest, RF) were 0.951, 0.892, 0.973, and 0.904, respectively. In the external validation, the AUC of RF was 0.940, with an accuracy of 0.875, a specificity of 0.875, and a sensitivity of 0.958. Conclusions Based on the preoperative OCT parameters and clinical variables, our ML model achieved remarkable accuracy in predicting IMH status after VILMP. Therefore, ML models may help optimize surgical planning for IMH patients in the future.
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Affiliation(s)
- Yu Xiao
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences; the Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences; the Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China.,Aier School of Ophthalmology, Central South University, Changsha, China
| | - Wuxiu Quan
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Bin Zhang
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Yuqing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Qiaowei Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences; the Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Baoyi Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences; the Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaomin Zeng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences; the Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhanjie Lin
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences; the Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ying Fang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences; the Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yu Hu
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Songfu Feng
- Department of Ophthalmology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ling Yuan
- Department of Ophthalmology, the First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Hongmin Cai
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital; Guangdong Academy of Medical Sciences; the Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Tao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Treatment outcomes of retinal vein occlusion in clinical practice in Nepal. BMC Ophthalmol 2021; 21:92. [PMID: 33602158 PMCID: PMC7890616 DOI: 10.1186/s12886-021-01857-y] [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: 07/24/2020] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study evaluated the treatment outcomes of retinal vein occlusion (RVO) in a routine clinical practice in Nepal. METHODS This was a retrospective analysis of observational data of patients with RVO who attended the retina clinic of the Tilganga Institute of Ophthalmology from 1 November 2017 to 31 October 2018. The main outcome was the mean change in visual acuity (VA) at 12 months from the start of treatment. Other outcomes of interest were the mean change in central subfield thickness (CST) and the number of treatments over 12 months. RESULTS A total of 99 eyes (of 99 patients) with RVO (60 - branch RVO [BRVO] and 39 - central RVO [CRVO] were available for the analysis. Eyes with CRVO had worse VA and CST at baseline. Eyes in both groups were similar for age, associated factors for RVO, duration of vision loss and the presence of ischemia at baseline. The mean (95% Confidence Interval [CI]) VA change at 12 months for BRVO was - 0.35 (- 0.46, - 0.23) logMAR (p < 0.001) from a mean (SD) of 0.75 (0.42) logMAR at baseline with 63% achieving VA < 0.3 logMAR while for CRVO it was - 0.35 (- 0.46, - 0.23) logMAR (p = 0.19) from 1.13 (0.61) logMAR at baseline and VA < 0.3 logMAR in 36%. The mean (95% CI) change in CST over 12 months was - 114 (- 189, - 40) μm (p = 0.003) from a mean (SD) of 423 (151) μm at baseline for BRVO and - 184(- 276, - 91) μm (p < 0.001) from 519 (213) μm for CRVO. Patients in both groups received a median of 2 bevacizumab injections over 12 months. Around 37% eyes were lost before 12 months' observation. The mean VA and CST trajectory in these eyes at their last visit was similar to those that completed 12 months. CONCLUSION The outcomes of RVO over the 12 months were inferior and the number of treatments fewer than those of the clinical trials and other reports from routine clinical practice. Future studies to identify the treatment barriers are warranted to improve the treatment outcomes in our patients.
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Hu Y, Xiao Y, Quan W, Zhang B, Wu Y, Wu Q, Liu B, Zeng X, Fang Y, Hu Y, Feng S, Yuan L, Li T, Cai H, Yu H. A multi-center study of prediction of macular hole status after vitrectomy and internal limiting membrane peeling by a deep learning model. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:51. [PMID: 33553344 PMCID: PMC7859800 DOI: 10.21037/atm-20-1789] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background To develop a deep learning (DL) model for prediction of idiopathic macular hole (MH) status after vitrectomy and internal limiting membrane peeling (VILMP) based on optical coherence tomography (OCT) images from four ophthalmic centers. Methods Eyes followed up at 1 month after VILMP for full-thickness MH were included. In the internal training set, 920 preoperative macular OCT images (as the input) and post-operative status of MH (closed or open, as the output) of 256 eyes from two ophthalmic centers were used to train the DL model using VGG16 algorithm. In the external validation set, 72 preoperative macular OCT images of 36 MH eyes treated by VILMP from another two ophthalmic centers were used to validate the prediction accuracy of the DL model. Results In internal training, the mean of overall accuracy for prediction of MH status after VILMP was 84.6% with a mean area under the receiver operating characteristic (ROC) curve (AUC) of 91.04% (sensitivity 85.37% and specificity 81.99%). In external validation, the overall accuracy of predicting MH status after VILMP was 84.7% with an AUC of 89.32% (sensitivity 83.33% and specificity 87.50%). The heatmaps showed that the area critical for prediction was at the central macula, mainly at the MH and its adjacent retina. Conclusions The DL model trained by preoperative macular OCT images can be used to predict postoperative MH status after VILMP. The prediction accuracy of our DL model has been validated by multiple ophthalmic centers.
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Affiliation(s)
- Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China.,Aier School of Ophthalmology, Central South University, Changsha, China
| | - Yu Xiao
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wuxiu Quan
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Bin Zhang
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Yuqing Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Qiaowei Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Baoyi Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xiaomin Zeng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Ying Fang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yu Hu
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Songfu Feng
- Department of Ophthalmology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Ling Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Hongmin Cai
- School of Computer Science and Engineering, South China University of Technology, Guangzhou, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Shrestha A, Shrestha C, Karki P, Gurung HM, Naito T. Strengthening retina eye care services in Nepal: retina eye care of Nepal project. BMC Health Serv Res 2020; 20:986. [PMID: 33109192 PMCID: PMC7590719 DOI: 10.1186/s12913-020-05850-x] [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: 06/02/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background Retinal diseases are very difficult to treat. So, early diagnoses and preventions are very important. But, few eye doctors can treat patients with retinal diseases in Nepal. Retina Eye Care of Nepal (RECON) project was designed to strengthen retina eye care services in Nepal. Methods RECON was implemented from May 2016 to February 2019 in Nepal. Four Master Eye Doctors (MED) received Training of Trainers (TOT) from Tokushima University, Japan. MEDs developed training materials for different cadres of ophthalmic human resources, enhanced retina eye care facilities, and conducted retina-screening camp in Nepal. Results Twenty ophthalmologists, 16 optometrists, 48 ophthalmic assistants and 17 ophthalmic nurses, 76 physicians and 28 health workers were trained in retina care. Eight outreach retina camps were conducted. Conclusions The project was a novel approach to strengthen retina services in Nepal. The aim of the project was accomplished with the ultimate benefits to the needy retina patients who otherwise were going to miss the retina services.
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Ngah NF, Muhamad NA, Asnir ZZ, Abdul Aziz RA, Mhad Kassim Z, Sahar SA, Ahmad Tarmidzi NA, Chan LY, Uthman R, Satar N, Husain NZ, Adnan A, Kayalakakathu JM, Kadas B, Mohamad NS, Kassim SA. Descriptive assessment on diabetic retinopathy screening in an awareness programme in Malaysia. Int J Ophthalmol 2020; 13:1808-1813. [PMID: 33215014 DOI: 10.18240/ijo.2020.11.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the prevalence of diabetic retinopathy (DR) among diabetic patients at the primary health clinics in Selangor, Malaysia. METHODS All diabetic patients were screened in Retinal Disease Awareness Programme (RDAP) and those who had significant DR changes were referred to the hospital for further management. Descriptive analyses were done to determine the prevalence of DR and sociodemographic characteristics among patients with diabetic. Univariate and multivariable analysis using Logistic regression were performed to find association and predictor factors in this screening. RESULTS A total of 3305 patients aged 40y and above were screened for DR. Of the patients screened, 9% patients were found to have DR and other visual complication such as maculopathy (0.9%), cataract (4.8%) and glaucoma (0.4%). The mean age of patients without retinopathy was 57.82±8.470y and the mean age of patients with DR was 63.93±9.857y. About 61.5% of the patients screened were aged below 60y and 38.5% were aged 60y and above. Majority of the patients screened were women 58.5% and Malay in the age group of 50-59y, while 27% were aged 60-69y. Significant association were found between age, sex, race, visual loss and DR. CONCLUSION Although the prevalence of DR among patients is not alarming, effective interventions need to be implemented soon to avert a large burden of visual loss from DR.
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Affiliation(s)
- Nor Fariza Ngah
- Department of Ophthalmology, Shah Alam Hospital, Selangor 40000, Malaysia
| | - Nor Asiah Muhamad
- Sector for Evidence Based Healthcare, National Institutes of Health, Ministry of Health, Selangor 40170, Malaysia.,Institute for Public Health, National Institutes of Health, Ministry of Health, Selangor 40170, Malaysia
| | | | | | | | - Siti Aishah Sahar
- Department of Ophthalmology, Putrajaya Hospital, Federal Territory 62250, Malaysia
| | | | - Li Yen Chan
- Department of Ophthalmology, Tengku Ampuan Rahimah Hospital, Selangor 41200, Malaysia
| | - Rosmawati Uthman
- Department of Ophthalmology, Selayang Hospital, Selangor 68100, Malaysia
| | - Narjis Satar
- Department of Ophthalmology, Sungai Buloh Hospital, Selangor 47000, Malaysia
| | - Noor Zahirah Husain
- Department of Ophthalmology, Kuala Lumpur Hospital, Federal Territory 50586, Malaysia
| | - Azian Adnan
- Department of Ophthalmology, Selayang Hospital, Selangor 68100, Malaysia
| | | | - Bariyah Kadas
- Selangor State Health Department, Ministry of Health, Selangor 40100, Malaysia
| | - Noor Suriani Mohamad
- Department of Ophthalmology, Tengku Ampuan Rahimah Hospital, Selangor 41200, Malaysia
| | - Shaiful Azlan Kassim
- Institute for Public Health, National Institutes of Health, Ministry of Health, Selangor 40170, Malaysia
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Thapa R, Khanal S, Tan HS, Thapa SS, van Rens GHMB. Prevalence, Pattern and Risk Factors of Retinal Diseases Among an Elderly Population in Nepal: The Bhaktapur Retina Study. Clin Ophthalmol 2020; 14:2109-2118. [PMID: 32801619 PMCID: PMC7399464 DOI: 10.2147/opth.s262131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/09/2020] [Indexed: 12/01/2022] Open
Abstract
Introduction Retinal diseases are an emerging cause of visual impairment in the developing world. The aim of this study was to explore the prevalence, pattern, and risk factors of retinal diseases in Nepal. Methods This is a population-based, cross-sectional study conducted from 2013 to 2015. The sample size was 2100 subjects age 60 years and above from 30 clusters of Bhaktapur district, Nepal. Detailed history, visual acuity, and anterior and posterior segment examinations were performed. Blood sugar and blood pressure were measured. Results Complete information was available for 1860 (88.57%) subjects. Mean age was 69.64±7.31 years, ranging from 60 to 95 years. The prevalence of any retinal disorder was 52.37% (95% confidence interval (CI): 50.07–54.66%). The prevalence of retinal disorders increased with ageing: 51.26% between 60 and 69 years and 53.05% among those age 80 years and above. Age-related macular degeneration (AMD) was the most common retinal disease (35.43%), followed by hypertensive retinopathy (4.35%), epiretinal membrane (ERM) (3.66%), branch retinal vein occlusion (BRVO) (2.90%), and diabetic retinopathy (DR) (2.15%). Other rare retinal disorders included myopic fundus (0.86%), chorioretinal scar (0.54%), retinal holes (0.32%), retinitis pigmentosa (0.32%), retinal detachment (0.16%), and coloboma (0.11%). In multivariate logistic regression analysis, those with prior cataract surgery (odds ratio (OR), 1.71; 95% CI: 1.32–2.22, p < 0.001) and systemic hypertension (OR, 1.21; 95% CI: 1.001–1.47, p = 0.049) had significantly increased retinal disorders. Conclusion Prevalence of retinal disorder was 52.37% at age 60 years and above. AMD, hypertensive retinopathy, ERM, BRVO, and DR were the most common retinal disorders. Retinal disorders increased with ageing. Retinal disorders were found associated with hypertension and prior cataract surgery. Timely screening, control of blood sugar and high blood pressure, and regular eye check-ups could help to save vision from retinal diseases.
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Affiliation(s)
- Raba Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal
| | - Hendra Stevie Tan
- Department of Ophthalmology, Amsterdam University Medical Center, Vrije University Amsterdam, Amsterdam, the Netherlands
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Rai BB, Morley MG, Bernstein PS, Maddess T. Pattern of vitreo-retinal diseases at the national referral hospital in Bhutan: a retrospective, hospital-based study. BMC Ophthalmol 2020; 20:51. [PMID: 32054472 PMCID: PMC7017569 DOI: 10.1186/s12886-020-01335-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowing the pattern and presentation of the diseases is critical for management strategies. To inform eye-care policy we quantified the pattern of vitreo-retinal (VR) diseases presenting at the national referral hospital in Bhutan. METHODS We reviewed all new patients over three years from the retinal clinic of the Jigme Dorji Wangchuck National Referral Hospital. Demographic data, presenting complaints and duration, treatment history, associated systemic diseases, diagnostic procedures performed, and final diagnoses were quantified. Comparisons of the expected and observed frequency of gender used Chi-squared tests. We applied a sampling with replacement based bootstrap analysis (10,000 cycles) to estimate the population means and the standard errors of the means and standard error of the 10th, 25th, 50th, 75th and 90th percentiles of the ages of the males and females within 20-year cohorts. We then applied t-tests employing the estimated means and standard errors. The 2913 subjects insured that the bootstrap estimates were statistically conservative. RESULTS The 2913 new cases were aged 47.2 ± 21.8 years. 1544 (53.0%) were males. Housewives (953, 32.7%) and farmers (648, 22.2%) were the commonest occupations. Poor vision (41.9%), screening for diabetic and hypertensive retinopathy (13.1%), referral (9.7%), sudden vision loss (9.3%), and trauma (8.0%) were the commonest presenting symptoms. Coexistent diabetes and hypertension were the most common associated systemic diseases. Haematological tests (blood sugar, HbA1c and lipid profile, 31.8%), OCT (27.4%), refraction (9.9%), B-scan (8.7%), fundus photography (8.0%) were the most commonly performed diagnostic tests. Hypertensive retinopathy (18.9%) was the commonest VR disease, followed by refractive errors referred for retinal evaluation (16.7%), diabetic retinopathy with macular oedema (15.8%), and AMD (11.0%). Retinal detachment was more prevalent in females (83 vs. 41, p = 0.007). Rare vision-threatening diseases like seasonal hyper-acute pan-uveitis also presented. CONCLUSIONS The developing VR service in Bhutan is challenged by the spectrum of diseases, limited human resources (e.g. one retinal surgeon during the study), and accessibility to tertiary eye-care services, all amidst difficult terrain. Sustained effort and robust coordination among the eye-care professionals, government and non-governmental organisations are critical for optimising VR services, especially as rates of diseases such as diabetes and hypertension grow.
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Affiliation(s)
- Bhim B Rai
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, 2601, Australia. .,Department of Ophthalmology, JDW National Referral Hospital, Thimphu, Bhutan.
| | - Michael G Morley
- Ophthalmic Consultants of Boston, Harvard Medical School, Boston, MA, USA
| | | | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, Canberra, ACT, 2601, Australia
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Rai BB, Shresthra MK, Thapa R, Essex RW, Paudyal G, Maddess T. Pattern and Presentation of Vitreo-Retinal Diseases: An Analysis of Retrospective Data at a Tertiary Eye Care Center in Nepal. Asia Pac J Ophthalmol (Phila) 2019; 8:481-488. [PMID: 31789651 PMCID: PMC6903420 DOI: 10.1097/01.apo.0000604400.50700.2d] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/18/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We examined patients presenting in a tertiary eye hospital in Nepal, focusing on information relevant to screening and management programs for vitreo-retinal (VR) disease. DESIGN Retrospective, cross-sectional study. METHODS We reviewed all patients presenting for the first time to the VR-clinic over 1 year. We quantified patient demography, symptoms and duration, systemic diseases, ophthalmological examinations, diagnostic investigations, and final diagnoses. RESULTS Of the 1905 cases, 1148 were male (60.3%). The 25th percentile of ages was 29 and 38 years for male and female, respectively; thus, female presented later (P < 0.0001). Hypertension was the commonest systemic disease (40.8%), followed by diabetes (32.5%). Age-related macular degeneration (AMD) and diabetic retinopathy (DR) affected 447 eyes (11.8%) and 416 eyes (10.9%), respectively. Male and female AMD and DR patients did not differ in age or disease duration. Similarly, age or disease duration for DR did not correlate with severity. Asymmetry of disease severity between eyes with AMD and DR was largest in patients with 1 normal eye. Presenting acuity was asymmetric between eyes (P < 0.0001) with people more often reporting once their right eyes had acuity of 6/18 or worse. CONCLUSIONS The screening of blood pressure and glucose levels combined with fundus photography could prevent many from progressing to life-changing visual impairment and blindness. Later reporting by females began at childbearing age; therefore, education and ocular screening could be usefully coupled in reproductive health programs. Clubbing VR disease screening with other established health programs like diabetes control program, hypertension clinics, school health program, and so on, would provide economical and sustainable approach.
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Affiliation(s)
- Bhim B. Rai
- John Curtin School of Medical Research, Australian National University, ACT, Australia
| | | | - Raba Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Rohan W. Essex
- ANU Academic Unit of Ophthalmology, ANU Medical School; Department of Ophthalmology, Canberra Hospital, ACT Health, Australia
| | | | - Ted Maddess
- John Curtin School of Medical Research, Australian National University, ACT, Australia
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Paudyal G, Shrestha MK, Poudel M, Tabin GC, Ruit S, Thomas BJ. Prevalence and Severity of Diabetic Retinopathy among Diabetic Patients Presenting to a Tertiary Eye Hospital in Nepal. Middle East Afr J Ophthalmol 2019; 26:210-215. [PMID: 32153332 PMCID: PMC7034152 DOI: 10.4103/meajo.meajo_65_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 09/23/2019] [Accepted: 10/07/2019] [Indexed: 12/02/2022] Open
Abstract
PURPOSE: The purpose of the study is to evaluate the prevalence and severity of diabetic retinopathy (DR) among all diabetic patients presenting to a tertiary eye care center in Nepal over a 3-year period. MATERIALS AND METHODS: This was a retrospective review of all clinical records from the initial presentations of diabetic patients at the Tilganga Institute of Ophthalmology (TIO) from 2012 to 2014. RESULTS: In total, 8855 patients were identified who presented to TIO with a prior diagnosis of diabetic mellitus (DM) during the study period. DR was found in 1714 patients (19.4%) at the time of initial presentation, 1305 (14.7%) of which had nonproliferative DR (PDR), while 617 (6.9%) demonstrated diabetic macular edema (DME) and 409 (4.6%) demonstrated PDR. Of the 1714 patients with DR, 825 (48.1%) required treatment at initial presentation for DME and/or PDR. Male gender, hypertension, age at presentation, and interval from diagnosis of DM to initial eye consultation were significantly associated with the presence of DR (P < 0.05). CONCLUSIONS: The prevalence of DR among patients with DM was 19.4%, which is lower than previously published estimates. However, among patients diagnosed with DR, over half presented with a vision-threatening complication warranting some measure of initial treatment.
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Affiliation(s)
| | | | - Manish Poudel
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Geoffrey C Tabin
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Sanduk Ruit
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
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Sokol JT, Ferenchak K, Rosen DT, Schechet SA, Skondra D. Macular Hole Formation After Pars Plana Vitrectomy for Diabetic Tractional Retinal Detachment. Ophthalmic Surg Lasers Imaging Retina 2019; 49:e256-e262. [PMID: 30566711 DOI: 10.3928/23258160-20181203-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate the incidence, clinical features, and outcomes of patients with macular hole (MH) formation after pars plana vitrectomy (PPV) for diabetic tractional retinal detachment (TRD). PATIENTS AND METHODS We conducted a retrospective review of all cases of PPV for diabetic TRD performed by a surgeon (DS) at a large county hospital between November 2013 and August 2016. RESULTS Ninety consecutive eyes of 79 patients were included in this case series, of which four eyes developed MH, yielding an incidence of 4.4% (95% confidence interval [CI], 1.2%-11.0%). The mean interval between PPV for TRD and MH formation was 7.0 ± 5.5 (mean ± 1 standard deviation) months, and mean follow-up time was 29.6 months ± 6.9 months. Three of the four eyes that developed MH underwent intervention, and of the three that underwent intervention, all had successful hole closure. CONCLUSION In this case series, the incidence of MH after PPV for TRD is 4.4% (95% CI, 1.2%-11.0%). The mechanism of MH formation after diabetic TRD repair is not certain but may be related to a taut internal limiting membrane, epiretinal membrane formation, macular edema, or residual vitreous contraction. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e256-e262.].
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19
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Thapa R, Twyana SN, Paudyal G, Khanal S, van Nispen R, Tan S, Thapa SS, van Rens G. Prevalence and risk factors of diabetic retinopathy among an elderly population with diabetes in Nepal: the Bhaktapur Retina Study. Clin Ophthalmol 2018; 12:561-568. [PMID: 29615832 PMCID: PMC5870654 DOI: 10.2147/opth.s157560] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Aim Diabetic retinopathy (DR) is an emerging cause of blindness in developing countries. This study aimed to explore the prevalence and risk factors of DR in an elderly population in Nepal. Subjects and methods This is a population-based, cross-sectional study. A total of 1860 subjects at the age 60 years and above participated (response rate 88.6%). A detailed history was obtained, presenting and best-corrected visual acuity were measured, and anterior segment and posterior segment examinations were carried out. Blood pressure and random blood sugar were recorded; body mass index was calculated, and abdominal girth was measured. DR was graded by clinical examination using Early Treatment Diabetic Retinopathy Study criteria. Results Diabetes was found in 168 (9%) subjects (mean age 69.6 years), 31 (18.5%) of whom were newly diagnosed. The prevalence of DR was 23.8% (95% confidence interval [CI]: 17.7%–31%) among the persons with diabetes. The prevalence of DR among newly diagnosed subjects with diabetes was 6.5% (95% CI: 0.8%–21.4%). The prevalence of vision-threatening DR was 9.5% (95% CI: 5.5%–15%) and was higher in males. The prevalence of DR was 83.3% (95% CI: 35.9%–99.6%) among those with diabetes for over 20 years. In multivariable logistic regression analysis, duration of diabetes, hypertension, and alcohol consumption were significantly associated with DR. Conclusion DR is a common problem among the elderly population with diabetes in Nepal. The duration of diabetes, hypertension, and alcohol consumption are the risk factors for the development of DR. Strategies have to be developed for timely diagnosis of diabetes and screening for DR.
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Affiliation(s)
- Raba Thapa
- Vitreo-retina Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Shankha N Twyana
- Department of Eye Bank, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Govinda Paudyal
- Vitreo-retina Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal
| | - Ruth van Nispen
- Department of Ophthalmology and the Amsterdam Public Health Research Institute, Vrije University Medical Center, Amsterdam, the Netherlands
| | - Stevie Tan
- Department of Ophthalmology and the Amsterdam Public Health Research Institute, Vrije University Medical Center, Amsterdam, the Netherlands
| | - Suman S Thapa
- Glaucoma Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Ghmb van Rens
- Department of Ophthalmology and the Amsterdam Public Health Research Institute, Vrije University Medical Center, Amsterdam, the Netherlands
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Thapa R, Bajimaya S, Paudyal G, Khanal S, Tan S, Thapa SS, van Rens GHMB. Prevalence and causes of low vision and blindness in an elderly population in Nepal: the Bhaktapur retina study. BMC Ophthalmol 2018; 18:42. [PMID: 29439666 PMCID: PMC5812211 DOI: 10.1186/s12886-018-0710-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/07/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND This study aims to explore the prevalence and causes of low vision and blindness focused on retinal disease in a population above 60 years in Nepal. METHODS Two thousand one hundred subjects were enrolled in a population-based cross-sectional study. History, presenting and best corrected visual acuity after subjective refraction, anterior and posterior segment examinations was obtained in detail. RESULTS Among the total subjects, 1860 (88.57%) had complete information. Age varies from 60 to 95 (mean age: 69.64 ± 7.31) years. Low vision and blindness in both eyes at presentation was found in 984 (52.90%, 95% confidence interval (CI): 50.60-55.19) and 36 (1.94%, 95% CI: 1.35-2.66) subjects respectively. After best correction, bilateral low vision and blindness was found in 426 (22.92%, 95% CI: 21.01-24.88), and 30 (1.61%, 95% CI: 0.10-2.30) subjects respectively. As compared to 60-69 years old, risk of visual impairment was four times higher (95% CI:3.26-5.58) in the 70-79 year olds and 14 times higher (95% CI: 9.72-19.73) in the age group 80 years and above. Major causes of bilateral low vision were cataract (68.07%), followed by retinal disorders (28.64%), and for blindness; retinal disorders (46.66%), followed by cataract (43.33%). Illiteracy was significantly associated with visual impairment. CONCLUSION Among the elderly population, prevalence of visual impairment was high. Refractive error, cataract and retinal disorders were the major cause of low vision. Screening the population at the age 60 years and above, focused on cataract and posterior segment diseases, providing glasses and timely referral can help reduce visual impairment.
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Affiliation(s)
- Raba Thapa
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, P O Box 561, Kathmandu, Nepal.
| | - Sanyam Bajimaya
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, P O Box 561, Kathmandu, Nepal
| | - Govinda Paudyal
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, P O Box 561, Kathmandu, Nepal
| | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal
| | - Stevie Tan
- Vrije University Medical Center, Amsterdam, The Netherlands
| | - Suman S Thapa
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, P O Box 561, Kathmandu, Nepal
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Nasrulloh AV, Willcocks CG, Jackson PTG, Geenen C, Habib MS, Steel DHW, Obara B. Multi-Scale Segmentation and Surface Fitting for Measuring 3-D Macular Holes. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:580-589. [PMID: 29408786 DOI: 10.1109/tmi.2017.2767908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Macular holes are blinding conditions, where a hole develops in the central part of retina, resulting in reduced central vision. The prognosis and treatment options are related to a number of variables, including the macular hole size and shape. High-resolution spectral domain optical coherence tomography allows precise imaging of the macular hole geometry in three dimensions, but the measurement of these by human observers is time-consuming and prone to high inter- and intra-observer variability, being characteristically measured in 2-D rather than 3-D. We introduce several novel techniques to automatically retrieve accurate 3-D measurements of the macular hole, including: surface area, base area, base diameter, top area, top diameter, height, and minimum diameter. Specifically, we introduce a multi-scale 3-D level set segmentation approach based on a state-of-the-art level set method, and we introduce novel curvature-based cutting and 3-D measurement procedures. The algorithm is fully automatic, and we validate our extracted measurements both qualitatively and quantitatively, where our results show the method to be robust across a variety of scenarios. Our automated processes are considered a significant contribution for clinical applications.
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Pandey A, Lamichhane G, Khanal R, Rai SKC, Bhari AM, Borroni D, Gautam N. Assessment of visual morbidity amongst diabetic retinopathy at tertiary eye care center, Nepal: a cross-sectional descriptive study. BMC Ophthalmol 2017; 17:263. [PMID: 29282017 PMCID: PMC5745597 DOI: 10.1186/s12886-017-0656-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is one of the leading causes of preventable blindness in low and middle income countries. In Nepal, there are less studies regarding DR and they too are limited around Kathmandu valley. This study was done to assess visual morbidity in patients with DR at a peripheral tertiary eye care center of Nepal. METHODS This was a prospective, hospital based, cross-sectional study in which all consecutive cases of DR were evaluated. DR was classified according to Early Treatment Diabetic Retinopathy Study Research Group - report no. 10 Table A5-1 (Modified Airlie House Classification). Data entry and analysis was done in an SPSS unit version 20. Wherever applicable, variables were set as 100 eyes. RESULTS Total number of patients included in this study was 50. Commonest age group was 50-69 yrs. (43/77 yrs.; min/max) comprising 80% of the total population (n = 50) and the predominant population was male (76%). Non proliferative diabetic retinopathy (NPDR) was found in 69%, proliferative diabetic retinopathy (PDR) in 31% and advanced diabetic eye disease (ADED) in 3% (n = 100). CONCLUSIONS All the stages of DR were present at significant proportions in this study, noteworthy was the percentage of PDR. This study shows an urgency to gather a national data on DR, raise awareness among diabetics and train effective man power at a local level to diagnose DR at an early stage.
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Affiliation(s)
| | | | | | | | | | | | - Narayan Gautam
- Universal College of Medical Sciences, Bhairahawa, Nepal
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Johnson CA, Thapa S, George Kong YX, Robin AL. Performance of an iPad Application to Detect Moderate and Advanced Visual Field Loss in Nepal. Am J Ophthalmol 2017; 182:147-154. [PMID: 28844641 DOI: 10.1016/j.ajo.2017.08.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 08/05/2017] [Accepted: 08/12/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the accuracy and efficiency of Visual Fields Easy (VFE), a free iPad app, for performing suprathreshold perimetric screening. DESIGN Prospective, cross-sectional validation study. METHODS We performed screening visual fields using a calibrated iPad 2 with the VFE application on 206 subjects (411 eyes): 210 normal (NL), 183 glaucoma (GL), and 18 diabetic retinopathy (DR) at Tilganga Institute of Ophthalmology, Kathmandu, Nepal. We correlated the results with a Humphrey Field Analyzer using 24-2 SITA Standard tests on 373 of these eyes (198 NL, 160 GL, 15 DR). RESULTS The number of missed locations on the VFE correlated with mean deviation (MD, r = 0.79), pattern standard deviation (PSD, r = 0.60), and number of locations that were worse than the 95% confidence limits for total deviation (r = 0.51) and pattern deviation (r = 0.68) using SITA Standard. iPad suprathreshold perimetry was able to detect most visual field deficits with moderate (MD of -6 to -12 dB) and advanced (MD worse than -12 dB) loss, but had greater difficulty in detecting early (MD better than -6 dB) loss, primarily owing to an elevated false-positive response rate. The average time to perform the Visual Fields Easy test was 3 minutes, 18 seconds (standard deviation = 16.88 seconds). DISCUSSION The Visual Fields Easy test procedure is a portable, fast, effective procedure for detecting moderate and advanced visual field loss. Improvements are currently underway to monitor eye and head tracking during testing, reduce testing time, improve performance, and eliminate the need to touch the video screen surface.
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Affiliation(s)
- Chris A Johnson
- Department of Ophthalmology and Visual Sciences, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
| | - Suman Thapa
- Nepal Glaucoma Eye Clinic, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Yu Xiang George Kong
- Cambridge University Hospital, NHS, Cambridge, United Kingdom; Centre of Eye Research Australia, Department of Ophthalmology, The University of Melbourne, Melbourne, Australia; Royal Victorian Eye and Ear Hospital, Victoria, Australia
| | - Alan L Robin
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland; Department of Ophthalmology, University of Michigan, Ann Arbor, Michigan
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Thapa R, Bajimaya S, Paudyal G, Khanal S, Tan S, Thapa SS, van Rens G. Prevalence, pattern and risk factors of retinal vein occlusion in an elderly population in Nepal: the Bhaktapur retina study. BMC Ophthalmol 2017; 17:162. [PMID: 28865424 PMCID: PMC5581447 DOI: 10.1186/s12886-017-0552-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 08/16/2017] [Indexed: 01/01/2023] Open
Abstract
Background This study aims to explore the prevalence, pattern and risk factors of retinal vein occlusion (RVO) in an elderly population of Nepal. Method One thousand eight hundred sixty subjects of age 60 years and above were enrolled in a population-based, cross-sectional study. Detailed history, visual acuity, anterior segment and posterior segment examinations were done. Blood pressure, non-fasting blood sugar, body mass index and abdominal girth were measured. Retinal vein occlusions were further divided into branch retinal (BRVO), hemi-retinal and central retinal vein occlusion (CRVO). Result Age ranged from 60 to 95 years with a mean of 69.64 ± 7.31 years. Overall population prevalence for RVO was 2.95% (95% Confidence interval (CI): 2.23–3.83), BRVO 2.74% (95% CI: 2.05–3.58) and CRVO 0.21% (95% CI: 0.06–0.55). BRVO was seen in 51 subjects (92.73%) and CRVO in 4 (7.27%). Among the total RVO, unilateral and bilateral involvement was 85.45% and 14.55%, respectively. Among the subjects with BRVO and CRVO, 37.25% and 50% had low vision, respectively. The risk of RVO increased with ageing and was more among males. There was an increased risk of RVO among those with hypertension, and with diabetes and hypertension. There was also an increased risk of RVO among subjects with hypermetropia, those with pseudophakia and those who were smokers and consumed alcohol. Conclusion Retinal vein occlusion is a common retinal vascular disorder in the elderly population of Nepal. The main risk factors for RVO were increasing age and hypertension.
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Affiliation(s)
- Raba Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal. .,Vitreo-retina Service, Tilganga Institute of Ophthalmology, P O Box, Kathmandu, 561, Nepal.
| | | | | | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal
| | - Stevie Tan
- Vrije University Medical Center, Amsterdam, The Netherlands
| | - Suman S Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Ger van Rens
- Vrije University Medical Center, Amsterdam, The Netherlands
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Thapa R, Bajimaya S, Paudyal G, Khanal S, Tan S, Thapa SS, van Rens G. Prevalence of and risk factors for age-related macular degeneration in Nepal: the Bhaktapur Retina Study. Clin Ophthalmol 2017; 11:963-972. [PMID: 28579747 PMCID: PMC5449112 DOI: 10.2147/opth.s132338] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aim This study aimed to explore the prevalence of and risk factors for age-related macular degeneration (AMD) in an elderly population in Nepal. Subjects and methods This is a population-based, cross-sectional study. A sample size of 2,100 was calculated. A total of 1,860 (88.6%) subjects aged >60 years were enrolled for the study from 30 clusters in the district. Detailed history, visual acuity, and anterior segment and posterior segment examinations were performed. AMD was graded according to the International ARM Epidemiological Study Group. Results Among the total study population, 659 subjects had any AMD (35.43%; 95% confidence interval [CI]: 33.25–37.65), 484 had mild dry AMD (26.02%; 95% CI: 24.04–28.08), 143 had intermediate dry AMD (7.69%; 95% CI: 6.52–8.99), 19 had geographic atrophy (1.02%; 95% CI: 0.61–1.59), and 13 had wet AMD (0.70%; 95% CI: 0.37–1.19). The overall prevalence of early and late AMD was 33.71% and 1.72%, respectively. Among subjects with dry and wet AMD, 36.53% and 46.1% had visual impairment, while 2.78% and 23.08% were blind, respectively. In multivariate analysis, AMD was significantly higher in subjects with an increased number of cigarettes smoked per day (odds ratio [OR] 1.02, 95% CI: 1.01–1.04; P=0.007) and in subjects with pseudophakia (OR 1.45, 95% CI: 1.12–1.87; P=0.005). Conclusion One-third of the population aged ≥60 years have some form of AMD. There was a significant association with the number of cigarettes consumed and with previous cataract surgery.
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Affiliation(s)
- Raba Thapa
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, Kathmandu
| | - Sanyam Bajimaya
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, Kathmandu
| | - Govinda Paudyal
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, Kathmandu
| | - Shankar Khanal
- Central Departments of Statistics, Tribhuvan University, Kirtipur, Nepal
| | - Stevie Tan
- Department of Ophthalmology, Vrije University Medical Center, Amsterdam, the Netherlands
| | - Suman S Thapa
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, Kathmandu
| | - Ger van Rens
- Department of Ophthalmology, Vrije University Medical Center, Amsterdam, the Netherlands
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Murthy GVS, Das T. Diabetic care initiatives to prevent blindness from diabetic retinopathy in India. Indian J Ophthalmol 2016; 64:50-4. [PMID: 26953024 PMCID: PMC4821122 DOI: 10.4103/0301-4738.178152] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
It is estimated that 65 million (17%) of 382 million persons with diabetes mellitus (DM) globally reside in India. While globally 35% persons with DM have diabetic retinopathy (DR), this proportion is reportedly lower in India, other countries in South Asia and China. We reviewed published data from 2008 onwards from PubMed, which ascertained DR in population-based representative samples. We also reviewed the risk factors for DR, on awareness regarding eye complications and on accessing an eye examination. Thirteen research studies have reported on the prevalence of DR among persons with DM; this prevalence was lower than the global level in China, India, and Nepal. Eleven studies reported DR risk factors association. The duration of diabetes and level of glycemic control were universally acknowledged DR risk factors. We identified 7 studies in the Asia region that researched the level of awareness about diabetes eye complications and the practice of accessing an eye examination. Excepting 1 study in China, others reported a significant proportion being aware that diabetes leads to eye complications. But the awareness was not translated into a positive practice-most studies reported only 20-50% of the persons with diabetes actually having had their eyes examined. The present review highlights the observation that the risk factors for DR need an integrated diabetic care pathway where the eye care team has to work in close collaboration and partnership with a diabetic care team has to reduce the risk of blindness from DR.
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Affiliation(s)
- G V S Murthy
- Indian Institute of Public Health, Public Health Foundation of India; Department of Clinical Research, Public Health Eye Care and Disability, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK,
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Thapa R, Bajimaya S, Bouman R, Paudyal G, Khanal S, Tan S, Thapa SS, van Rens G. Intra- and inter-rater agreement between an ophthalmologist and mid-level ophthalmic personnel to diagnose retinal diseases based on fundus photographs at a primary eye center in Nepal: the Bhaktapur Retina Study. BMC Ophthalmol 2016; 16:112. [PMID: 27430579 PMCID: PMC4950770 DOI: 10.1186/s12886-016-0295-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 07/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early detection can reduce irreversible blindness from retinal diseases. This study aims to assess the intra- and inter-rater agreement of retinal pathologies observed on fundus photographs between an ophthalmologist and two-mid level ophthalmic personnel (MLOPs). METHOD A population-based, cross-sectional study was conducted among subjects 60 years and above in the Bhaktapur district of Nepal. Fundus photographs of 500 eyes of 500 subjects were assessed. The macula-centered 45-degree photographs were graded twice by one ophthalmologist and two MLOPs. Intra-rater and inter-rater agreements were assessed for the ophthalmologist and the MLOPs. RESULT Mean age was 70.22 years ± 6.94 (SD). Retinal pathologies were observed in 55.6 % of photographs (age-related macular degeneration: 34.2 %; diabetic retinopathy: 4.2 %; retinal vein occlusion: 3.8 %). Twelve (2.4 %) fundus pictures were non-gradable. The intra-rater agreement for overall retinal pathologies, retinal hemorrhage, and maculopathy were substantial both for the ophthalmologist as well as for the MLOPs. There was moderate inter-rater agreement between the ophthalmologist and the first MLOP on second rating for overall retinal pathologies, [kappa (k); 95 % CI = 0.59 (0.51-0.66)], retinal hemorrhage [k; 95 % CI = 0.60 (0.41-0.78)], and maculopathy [k; 95 % CI = 0.52 (0.43-0.60)]. Inter-rater agreement between the ophthalmologist and the second MLOP for second rating was moderate for overall retinal pathologies [k; 95 % CI = 0.52 (0.44-0.60)], substantial agreement for retinal hemorrhage [k; 95 % CI = 0. 68 (0.52-0.84)], moderate agreement for maculopathy [k; 95 % CI = 0.59 (0.50-0.67)]. CONCLUSION There is moderate agreement between the MLOPs and the ophthalmologist in grading fundus photographs for retinal hemorrhages and maculopathy.
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Affiliation(s)
- Raba Thapa
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal.
| | - Sanyam Bajimaya
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal
| | - Renske Bouman
- Vrije University Medical Center, Amsterdam, The Netherlands
| | - Govinda Paudyal
- Vitreo-retina Service, Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal
| | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal
| | - Stevie Tan
- Vrije University Medical Center, Amsterdam, The Netherlands
| | - Suman S Thapa
- Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Ger van Rens
- Vrije University Medical Center, Amsterdam, The Netherlands
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Thapa R, Bajimaya S, Paudyal G, Khanal S, Tan S, Thapa SS, van Rens G. Population awareness of diabetic eye disease and age related macular degeneration in Nepal: the Bhaktapur Retina Study. BMC Ophthalmol 2015; 15:188. [PMID: 26714483 PMCID: PMC4696239 DOI: 10.1186/s12886-015-0175-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/16/2015] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) and age-related macular degeneration (AMD) are among the leading causes of visual impairment and blindness in developing countries. This study aims to explore the awareness of these retinal diseases in Nepal. METHOD A population based cross-sectional study conducted among individuals 60 years and older from the Bhaktapur district of Nepal. One thousand consecutive subjects were enrolled and subjected to a structured questionnaire. RESULT Subject age ranged from 60 to 93 years with a meanof 69.5 years ± 7.1(S.D.). Males and females comprised 45.1 and 55.9 % of the population, respectively. The majority was illiterate (78.2 %), and agriculture was the predominant occupation (79.8 %). 12.1 % were aware of the effect of diabetes on the eye, and among them, 99 % were aware that diabetes was a blinding disease caused by DR.11.5 % of the subjects were aware of DR, and 10.1 % were aware that subjects with diabetes should undergo periodic eye examinations. Only 7.6 % of subjects were aware of AMD.7.5 and 7.4 % were aware about its aggravation with smoking and sunlight exposure, respectively. Younger age group, males, literates, service holders, best corrected visual acuity >0.3 LogMAR, were each significantly associated with an increase in awareness of diabetic retinopathy. Smokers and those with agricultural occupations were less aware regarding AMD. Those with diabetes,with or without DRwere significantly more aware than those not having the disease. CONCLUSION Among the Bhaktapur population, awareness of DR and AMD was only 11.5 and7.6 % respectively. Older age groups, females, illiterates, farmers, and those with poor visual acuity were less aware of these blinding diseases. We recommend community-based eye health education programs targeted at raising awareness of these diseases and preventive measures.
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Affiliation(s)
- Raba Thapa
- Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal.
| | - Sanyam Bajimaya
- Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal.
| | - Govinda Paudyal
- Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal.
| | - Shankar Khanal
- Central Department of Statistics, Tribhuvan University, Kirtipur, Nepal.
| | - Stevie Tan
- Vrije University Medical Center, Amsterdam, The Netherlands.
| | - Suman S Thapa
- Tilganga Institute of Ophthalmology, P O Box: 561, Kathmandu, Nepal.
| | - Ger van Rens
- Vrije University Medical Center, Amsterdam, The Netherlands.
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A review of current management of vitreomacular traction and macular hole. J Ophthalmol 2015; 2015:809640. [PMID: 25821592 PMCID: PMC4363823 DOI: 10.1155/2015/809640] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/20/2014] [Indexed: 12/31/2022] Open
Abstract
The paper presents a review of the sequence of events of posterior vitreous detachment (PVD), vitreomacular adhesion (VMA), vitreomacular traction (VMT), and macular hole (MH) from their pathophysiological aspects, clinical features, diagnostic implications, and current management strategies. A treatment algorithm to be used in clinical practice in patients with VMA, VMT, and MH based on the presence of symptoms, visual acuity, associated epiretinal membrane, and width of the vitreous attachment is presented. Observation, pharmacologic vitreolysis with ocriplasmin, and surgical treatment are positioned as treatment options in the different steps of the therapeutic algorithm, with clear indications of the paths to be followed according to the initial presenting manifestations and the patient's clinical course.
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The Prevalence of Age-Related Eye Diseases and Cataract Surgery among Older Adults in the City of Lodz, Poland. J Ophthalmol 2015; 2015:605814. [PMID: 25789169 PMCID: PMC4350620 DOI: 10.1155/2015/605814] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 02/07/2015] [Accepted: 02/09/2015] [Indexed: 11/17/2022] Open
Abstract
Purpose. To determine the prevalence of age-related eye diseases and cataract surgery among older adults in the city of Lodz, in central Poland. Material and Methods. The study design was cross-sectional and observational study. A total of 1107 women and men of predominantly Caucasian origin were successfully enumerated and recruited for the study. All selected subjects were interviewed and underwent detailed ophthalmic examinations. Results. Overall 8.04% (95% CI 6.44-9.64) subjects had cataract surgery in either eye. After excluding subjects with bilateral cataract surgery, the prevalence of cataract was 12.10% (95% CI 10.18-14.03). AMD was found in 4.33% (95% CI 3.14-5.54 ) of all subjects. Of them 3.25% (95% CI 2.21-4.30 ) had early AMD and 1.08% (95% CI 0.47-1.69) had late AMD. Various types of glaucoma were diagnosed in 5.51% (95% CI 4.17-6.85) of subjects and 2.62% (95% CI 1.68-3.56) had OHT. The prevalence rates of DR and myopic macular degeneration were 1.72% (95% CI 0.95-2.48) and 0.45% (95% CI 0.06-0.85), respectively. All multiple logistic regression models were only significantly associated with older age. The highest rate of visual impairment was observed among subjects with retinal diseases. Conclusions. The study revealed high prevalence of age-related eye diseases in this older population.
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Idiopathic vitreomacular traction and macular hole: a comprehensive review of pathophysiology, diagnosis, and treatment. Eye (Lond) 2014; 27 Suppl 1:S1-21. [PMID: 24108069 PMCID: PMC3797995 DOI: 10.1038/eye.2013.212] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Posterior vitreous detachment (PVD) is a common phenomenon in the aging eye. However, this may be complicated by persistent symptomatic vitreomacular adhesions that exert tractional forces on the macula (vitreomacular traction; VMT). VMT itself may be associated with epiretinal membrane formation and the development of idiopathic macular holes (IMH). Such pathologies may cause visual disturbances, including metamorphopsia, photopsia, blurred vision, and decreased visual acuity, which impact an individual's quality of life. Technologies such as optical coherence tomography allow an increasingly more accurate visualisation of the macular anatomy, including quantification of macular hole characteristics, and this facilitates treatment decision-making. Pars plana vitrectomy remains the primary treatment option for many patients with VMT or IMH; for the latter, peeling of the inner limiting membrane (ILM) of the retina has shown improved outcomes when compared with no ILM peeling. The development of narrow-gauge transconjunctival vitrectomy systems has improved the rate of visual recovery following surgery. Ocriplasmin, by degrading laminin and fibronectin at the vitreoretinal interface, may allow induction of PVD in a non-invasive manner. Indeed, clinical studies have supported its use as an alternative to surgery in certain patient populations. However, further research is still needed with respect to greater understanding of the pathophysiology underlying the development of VMT and IMH.
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