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Jones A, Vijayan TB, John S. Diagnosing Cataracts in the Digital Age: A Survey on AI, Metaverse, and Digital Twin Applications. Semin Ophthalmol 2024:1-8. [PMID: 39300918 DOI: 10.1080/08820538.2024.2403436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 08/21/2024] [Accepted: 09/02/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE The study explores the evolving landscape of cataract diagnosis, focusing on both traditional methods and innovative technological integrations. It aims to address challenges with subjectivity in traditional cataract grading and to evaluate how new technologies can enhance diagnostic accuracy and accessibility. METHODS The research introduces and examines the use of Artificial Intelligence (AI), Machine Learning (ML), and Deep Learning (DL) in automating and improving cataract screening processes. It also explores the role of the Metaverse, Digital Twins, and Teleophthalmology for immersive patient education, real-time virtual replicas of eyes, and remote access to specialized care. RESULTS Various ML and DL techniques demonstrated significant accuracy in cataract detection. The integration of these technologies, along with the Metaverse, Digital Twins, and Teleophthalmology, provides a comprehensive framework for accurate and accessible cataract diagnosis. CONCLUSION There is a notable paradigm shift toward individualized, predictive, and transformative eye care. The advancements in technology address existing diagnostic challenges and mitigate the shortage of ophthalmologists by extending high-quality care to underserved regions. These developments pave the way for improved cataract management and broader accessibility.
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Affiliation(s)
- Aida Jones
- Department of ECE, KCG College of Technology, Chennai, India
| | | | - Sheila John
- Department of Teleophthalmology, Sankara Nethralaya, Medical Research Foundation, Chennai, India
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Oganov AC, Chou TY, Hanson PM, Abazari A, Kung P, Weissbart SB, Lenoci JN, Honkanen RA. Telemedicine at a University Ophthalmology Practice During the Beginning of the COVID-19 Pandemic. Clin Ophthalmol 2024; 18:2369-2380. [PMID: 39193320 PMCID: PMC11348924 DOI: 10.2147/opth.s460454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024] Open
Abstract
Purpose The aim of the research was to evaluate the use of teleophthalmology at a university practice during the COVID-19 pandemic, specifically examining precision, effectiveness, and patient satisfaction. Patients and Methods Telemedicine visits were offered to new and established patients requesting appointments with the Stony Brook University Department of Ophthalmology between March 30 and June 2, 2020. Records from these visits were reviewed for chief complaint, past medical and ocular history, diagnoses, treatment/management, and providers' sub-specialty. Precision was determined by comparing agreement between diagnoses of the telemedicine visit with those of the subsequent in-person visit. The decision to follow up in person was made by the physician and patient. Diagnostic precision as well as progression, improvement, or stability of patients' symptoms were determined by the physician's assessment at follow-up visits. Post-telemedicine visit satisfaction surveys were sent to all patients. Results Telemedicine visits were offered to 783 patients, 520 (66.4%) of whom accepted. Of these 520 patients, 409 (78.7%) were established and 105 (20.2%) had in-person, follow-up visits. Overall, the diagnostic precision of the follow-up visits was 89.5%. Precision differed significantly across ophthalmologic subspecialties. Of the patients who had in-person follow-up visits, 56.8% remained stable, 32.4% improved, and 10.8% worsened. Established patients presented with more extensive ocular histories/procedures and experienced a higher percentage of worsening symptoms/disease stage compared to new patients. Oculoplastics/orbit was the most prevalent diagnostic subspecialty that worsened. Surveys were sent to all patients completing telemedicine visits, 15.0% of whom responded. Overall satisfaction was 91.9%, although only 23.0% of respondents preferred telemedicine to an in-office visit. Conclusion Telehealth provides high levels of precision and patient satisfaction for a wide range of ophthalmologic visits, although most patients still prefer in-office examinations. Employing teleophthalmology for follow-up and emergency care may provide patients with an effective alternative during pandemic situations and beyond.
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Affiliation(s)
- Anthony C Oganov
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Timothy Y Chou
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Paris M Hanson
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Azin Abazari
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Preston Kung
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Sarah B Weissbart
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Jacqueline N Lenoci
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
| | - Robert A Honkanen
- Department of Ophthalmology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, 11974, USA
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Kaushik N, Sharma P, Himori N, Matsumoto T, Miya T, Nakazawa T. Mobile infrared slit-light scanner for rapid eye disease screening. J Med Imaging (Bellingham) 2024; 11:026003. [PMID: 38606184 PMCID: PMC11003872 DOI: 10.1117/1.jmi.11.2.026003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024] Open
Abstract
Purpose Timely detection and treatment of visual impairments and age-related eye diseases are essential for maintaining a longer, healthier life. However, the shortage of appropriate medical equipment often impedes early detection. We have developed a portable self-imaging slit-light device utilizing NIR light and a scanning mirror. The objective of our study is to assess the accuracy and compare the performance of our device with conventional nonportable slit-lamp microscopes and anterior segment optical coherence tomography (AS-OCT) for screening and remotely diagnosing eye diseases, such as cataracts and glaucoma, outside of an eye clinic. Approach The NIR light provides an advantage as measurements are nonmydriatic and less traumatic for patients. A cross-sectional study involving Japanese adults was conducted. Cataract evaluation was performed using photographs captured by the device. Van-Herick grading was assessed by the ratio of peripheral anterior chamber depth to peripheral corneal thickness, in addition to the iridocorneal angle using Image J software. Results The correlation coefficient between values obtained by AS-OCT, and our fabricated portable scanning slit-light device was notably high. The results indicate that our portable device is equally reliable as the conventional nonportable slit-lamp microscope and AS-OCT for screening and evaluating eye diseases. Conclusions Our fabricated device matches the functionality of the traditional slit lamp, offering a cost-effective and portable solution. Ideal for remote locations, healthcare facilities, or areas affected by disasters, our scanning slit-light device can provide easy access to initial eye examinations and supports digital eye healthcare initiatives.
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Affiliation(s)
- Neelam Kaushik
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
| | - Parmanand Sharma
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
- Tohoku University Graduate School of Medicine, Advanced Research Center for Innovations in Next-Generation Medicine, Sendai, Japan
| | - Noriko Himori
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
- Tohoku University Graduate School of Biomedical Engineering, Department of Aging Vision Healthcare, Sendai, Japan
| | - Takuro Matsumoto
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
| | - Takehiro Miya
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
| | - Toru Nakazawa
- Tohoku University Graduate School of Medicine, Department of Ophthalmology, Sendai, Japan
- Tohoku University Graduate School of Medicine, Advanced Research Center for Innovations in Next-Generation Medicine, Sendai, Japan
- Tohoku University Graduate School of Medicine, Department of Retinal Disease Control, Sendai, Japan
- Tohoku University Graduate School of Medicine, Department of Ophthalmic Imaging and Information Analytics, Sendai, Japan
- Tohoku University Graduate School of Medicine, Department of Advanced Ophthalmic Medicine, Sendai, Japan
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Shimizu E, Ishikawa T, Tanji M, Agata N, Nakayama S, Nakahara Y, Yokoiwa R, Sato S, Hanyuda A, Ogawa Y, Hirayama M, Tsubota K, Sato Y, Shimazaki J, Negishi K. Artificial intelligence to estimate the tear film breakup time and diagnose dry eye disease. Sci Rep 2023; 13:5822. [PMID: 37037877 PMCID: PMC10085985 DOI: 10.1038/s41598-023-33021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/06/2023] [Indexed: 04/12/2023] Open
Abstract
The use of artificial intelligence (AI) in the diagnosis of dry eye disease (DED) remains limited due to the lack of standardized image formats and analysis models. To overcome these issues, we used the Smart Eye Camera (SEC), a video-recordable slit-lamp device, and collected videos of the anterior segment of the eye. This study aimed to evaluate the accuracy of the AI algorithm in estimating the tear film breakup time and apply this model for the diagnosis of DED according to the Asia Dry Eye Society (ADES) DED diagnostic criteria. Using the retrospectively corrected DED videos of 158 eyes from 79 patients, 22,172 frames were annotated by the DED specialist to label whether or not the frame had breakup. The AI algorithm was developed using the training dataset and machine learning. The DED criteria of the ADES was used to determine the diagnostic performance. The accuracy of tear film breakup time estimation was 0.789 (95% confidence interval (CI) 0.769-0.809), and the area under the receiver operating characteristic curve of this AI model was 0.877 (95% CI 0.861-0.893). The sensitivity and specificity of this AI model for the diagnosis of DED was 0.778 (95% CI 0.572-0.912) and 0.857 (95% CI 0.564-0.866), respectively. We successfully developed a novel AI-based diagnostic model for DED. Our diagnostic model has the potential to enable ophthalmology examination outside hospitals and clinics.
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Affiliation(s)
- Eisuke Shimizu
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan.
- Yokohama Keiai Eye Clinic, Courtley House 2F, 1-11-17 Wada, Hodogaya-ku, Kanagawa, 240-0065, Japan.
| | - Toshiki Ishikawa
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Makoto Tanji
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Naomichi Agata
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Shintaro Nakayama
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Yo Nakahara
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Ryota Yokoiwa
- OUI Inc., DF Building 510, 2-2-8 Minami-Aoyama, Minato-ku, Tokyo, 107-0062, Japan
| | - Shinri Sato
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Yokohama Keiai Eye Clinic, Courtley House 2F, 1-11-17 Wada, Hodogaya-ku, Kanagawa, 240-0065, Japan
| | - Akiko Hanyuda
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoko Ogawa
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masatoshi Hirayama
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yasunori Sato
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa-shi, Chiba, 272-8513, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Telemedicine for Retinal Disease During the COVID-19 Pandemic: Survey of the Patient Perspective. Ophthalmol Ther 2022; 11:1925-1936. [PMID: 35922710 PMCID: PMC9362715 DOI: 10.1007/s40123-022-00555-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/25/2022] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Amidst the COVID-19 pandemic, telemedicine has emerged as a safe and cost-effective alternative to traditional ophthalmology clinic visits. This study evaluated patient attitudes towards telemedicine at a full-service, retina-only practice to identify areas for growth in implementation. METHODS A survey was distributed to established patients at University Retina and Macula Associates following the completion of a telemedicine encounter in July 2021. On a 5-point Likert scale, patients compared telemedicine to in-person visits for six domains: ability to ease COVID-related anxiety, efficiency, patient education, quality of care, fulfillment of personal needs, and convenience. Pearson's χ2 and Fisher's exact test were used to assess correlations between demographic factors and patient attitudes or preference towards telemedicine. RESULTS Among 103 respondents, two-thirds (68.7%) preferred in-person compared to telemedicine encounters. Overall, patients had a neutral attitude towards telemedicine [mean Likert rating (SD) = 3.11/5 ± 0.82]. Questions assessing "patient education" and "telemedicine efficiency" received the greatest proportion of positive and negative responses, respectively. Positive attitudes were more frequent among patients with prior telemedicine experience (87.5%) compared to never-users (71.8%; p = 0.046). Patients ≥ 75 years old tended to negatively assess telemedicine regarding reduction of COVID-19-related anxiety, efficiency, patient education, and physician facetime (p < 0.05 for all). A positive but non-significant trend was observed between higher education level and positive attitude towards telemedicine (p = 0.18). Telehealth never-users more often negatively rated receiving adequate facetime with the physician virtually (54.7%) compared to prior users (25.6%; p = 0.004). Younger age, prior history of telemedicine use, and higher education level were associated with increased preference for telemedicine (p < 0.05 for all). CONCLUSION Our findings revealed hesitance remains among patients towards adoption of telemedicine. Targeting age-, experience-, and education-related barriers will be invaluable for increasing acceptance of this healthcare delivery model.
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Omari A, Samad M, Bakhsh SR, Tajran J, Williams GA. Accuracy of Remote Diagnosis of Acute Posterior Segment Pathology by Residents and Attendings Captured with a Smartphone and Standard 20/28D Lens. Clin Ophthalmol 2022; 16:2751-2757. [PMID: 36035242 PMCID: PMC9416298 DOI: 10.2147/opth.s364765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 06/02/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Amro Omari
- Beaumont Eye Institute, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
- Correspondence: Amro Omari, Beaumont Eye Institute, 3535 West 13 Mile Road Suite #555, Royal Oak, MI, 48073, USA, Tel +1 248-551-2020, Email
| | - Momin Samad
- Michigan State College of Human Medicine, Grand Rapids, MI, USA
| | - Saaquib R Bakhsh
- Beaumont Eye Institute, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Jahan Tajran
- Wayne State University School of Medicine, Detroit, MI, USA
| | - George A Williams
- Beaumont Eye Institute, Royal Oak, MI, USA
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
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Automated method for real-time AMD screening of fundus images dedicated for mobile devices. Med Biol Eng Comput 2022; 60:1449-1479. [DOI: 10.1007/s11517-022-02546-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/06/2022] [Indexed: 01/01/2023]
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Applications and Outcomes of Internet of Things for Patients with Alzheimer’s Disease/Dementia: A Scoping Review. BIOMED RESEARCH INTERNATIONAL 2022; 2022:6274185. [PMID: 35342749 PMCID: PMC8948545 DOI: 10.1155/2022/6274185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 11/24/2022]
Abstract
Objectives We aimed to identify and classify the Internet of Things (IoT) technologies used for Alzheimer's disease (AD)/dementia as well as the healthcare aspects addressed by these technologies and the outcomes of the IoT interventions. Methodology. We searched PubMed/MEDLINE, IEEE Explore, Web of Science, OVID, Scopus, Embase, Cochrane, and Google Scholar. In total, 13,005 papers were reviewed, 36 of which were finally selected. All the reviews were independently carried out by two researchers. In the case of any disagreement, the problem was resolved by holding a meeting and exchanging views. Due to the diversity of the reviewed studies, narrative analysis was performed. Results Among the technologies used for the patients including radio frequency identification (RFID), near field communication (NFC), ZigBee, Bluetooth, global positioning system (GPS), sensors, and cameras, the sensors were employed in 36 studies, most of which were switch and vital sign monitoring sensors. The most common aspects of AD/dementia care monitored using these technologies were activities of daily living (ADLs) in 27 studies, followed by sleep patterns and disease diagnosis in 19 and 14 studies, respectively. Sleeping, medication, vital signs, agitation, memory, social interaction, apathy, movement, tracking, and fall were other aspects monitored by IoT. Then, their outcomes were reported. Conclusion Using IoT for AD/dementia provides many opportunities for considering various aspects of this disease. Moreover, the ability to use various technologies for gathering patient-related data provides a comprehensive application for almost all aspects of the patients' care with high accuracy.
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Chawla S, Chawla A, Chawla R, Jaggi S, Singh D, Trehan S. Trained nurse–operated teleophthalmology screening approach as a cost-effective tool for diabetic retinopathy. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-021-01037-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Development of 3D Printed Smartphone-Based Multi-Purpose Fundus Camera (MultiScope) for Retinopathy of Prematurity. Ann Biomed Eng 2021; 49:3323-3338. [PMID: 34773157 DOI: 10.1007/s10439-021-02885-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022]
Abstract
Retinopathy of Prematurity (ROP) is a prominent source of low vision and blindness in preterm babies. Wide-Field Digital Retinal Imaging (WFDRI) systems acquire accurate digital images which are very useful for identification, documentation and transmitting the various retinal diseases. This telemedicine technique has potential for an alternative tool for Binocular Indirect Ophthalmoscopy (BIO) in ROP screening, but it is very expensive and accessibility for poor communities is limited. Capabilities of good illumination, high resolution camera and processing speed of the modern smartphones are being identified as a substitute. Potential applications of 3D printing is that it provides a severe impact in medical field, especially in ophthalmology sector. Competences of 3D printing are very useful for the development of retinal camera from any smartphone with the help of 3D printable devices. The primary aim of this study is to develop a handheld 3D printed smartphone-based multi-purpose fundus camera for ROP screening. The secondary aim is to check the feasibility and compare the digital fundus images obtained from the developed fundus camera against the commercial RetCam imaging. The proposed cost effective and remote reading device is an alternative to WFDRI for ROP screening and can improve the potential of ROP care for low resource communities.
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Kalra G, Ichhpujani P, Thakur S, Sharma U. Ideal Illumination for Smartphone-based Trabeculectomy Bleb Photography. J Ophthalmic Vis Res 2021; 16:357-366. [PMID: 34394864 PMCID: PMC8358752 DOI: 10.18502/jovr.v16i3.9432] [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: 08/02/2020] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Ophthalmology has seen numerous novel uses for smartphones over the years including fundus photography, telemedicine, and operative videography. However, anterior segment photography for assessing and documenting trabeculectomy bleb morphology using a smartphone has not been explored in detail. With the current study, we aim to characterize ideal illumination for the anterior segment smartphone photography in trabeculectomy patients. Methods Thirty status post-trabeculectomy patients were enrolled in this study. Native camera application and FiLMiC pro camera application were used on iPhone X to compare bleb images using yellow and white pen-torches as illumination source. Measured bleb area was compared using ImageJ software from the two apps in different illumination settings by charting boxplots and using one-way ANOVA test using R software to establish consistency. Bland-Altman interoperability for repeatability of bleb-area measurements was analyzed by plotting Bland-Altman plots. Signal-to-noise ratio was calculated using ImageJ for native camera images using slit-lamp camera images as reference. Subjective rating of these images was then performed by two experienced ophthalmologists and kappa coefficient was calculated for inter-operator repeatability. Statistical analysis was performed. Results The measured bleb area from images taken from both apps showed no significant difference, thereby establishing consistency, and Bland-Altman analysis indicated good repeatability and reproducibility. It was noted that SNR was lower for images shot in close illumination as compared to the ones shot in intermediate and distant illumination. Cohen's kappa coefficient was 0.7 for images with distant illumination using white light and 0.65 for images clicked with illumination at an intermediate distance using yellow light, suggesting substantial agreement between the observers. Conclusion Smartphone photography is a reliable tool for morphological assessment trabeculectomy blebs. Optimal illumination helps achieve results free from digital noise and better delineation of specific morphological features. Intermediate illumination and distant illumination provides much better results in terms of high SNR while avoiding overexposure and clipping of highlight information in the images.
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Affiliation(s)
- Gagan Kalra
- Department of Ophthalmology, Government Medical College and Hospital, Sector-32, Chandigarh, India
| | - Parul Ichhpujani
- Department of Ophthalmology, Government Medical College and Hospital, Sector-32, Chandigarh, India
| | - Sahil Thakur
- Department of Ocular Epidemiology, Singapore Eye Research Institute, Singapore
| | - Urvashi Sharma
- Department of Ophthalmology, Government Medical College and Hospital, Sector-32, Chandigarh, India
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Abstract
Purpose of Review The field of teleglaucoma has expanded rapidly in recent years with several large-scale teleglaucoma screening programs in existence throughout the world. Additionally, teleglaucoma programs for use in disease management are under study. The limited access to care that resulted from the COVID-19 pandemic highlighted the need for expansion of such programs. This article reviews the literature on teleglaucoma for screening and management of glaucoma, discussing considerations for incorporating teleglaucoma into clinical practice. Recent Findings Teleglaucoma screening reduces the rate of false-positive referrals and can accurately screen at-risk populations with accuracy similar to in-person screening. The use of teleglaucoma for the management of glaucoma shows promise for low-risk patients with early disease. Furthermore, teleglaucoma is cost-effective and reduces travel burden for patients resulting in high patient satisfaction. Summary Teleglaucoma offers potential for improving access to glaucoma care, reducing the burden on patients and health care systems.
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Jansen LG, Shah P, Wabbels B, Holz FG, Finger RP, Wintergerst MWM. Learning curve evaluation upskilling retinal imaging using smartphones. Sci Rep 2021; 11:12691. [PMID: 34135452 PMCID: PMC8209054 DOI: 10.1038/s41598-021-92232-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/31/2021] [Indexed: 12/04/2022] Open
Abstract
Smartphone-based fundus imaging (SBFI) is a low-cost approach for screening of various ophthalmic diseases and particularly suited to resource limited settings. Thus, we assessed how best to upskill alternative healthcare cadres in SBFI and whether quality of obtained images is comparable to ophthalmologists. Ophthalmic assistants and ophthalmologists received a standardized training to SBFI (Heine iC2 combined with an iPhone 6) and 10 training examinations for capturing central retinal images. Examination time, total number of images, image alignment, usable field-of-view, and image quality (sharpness/focus, reflex artifacts, contrast/illumination) were analyzed. Thirty examiners (14 ophthalmic assistants and 16 ophthalmologists) and 14 volunteer test subjects were included. Mean examination time (1st and 10th training, respectively: 2.17 ± 1.54 and 0.56 ± 0.51 min, p < .0001), usable field-of-view (92 ± 16% and 98 ± 6.0%, p = .003) and image quality in terms of sharpness/focus (p = .002) improved by the training. Examination time was significantly shorter for ophthalmologists compared to ophthalmic assistants (10th training: 0.35 ± 0.21 and 0.79 ± 0.65 min, p = .011), but there was no significant difference in usable field-of-view and image quality. This study demonstrates the high learnability of SBFI with a relatively short training and mostly comparable results across healthcare cadres. The results will aid implementing and planning further SBFI field studies.
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Affiliation(s)
- Linus G Jansen
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Payal Shah
- Sankara Academy of Vision, Sankara Eye Hospital Bangalore, Varthur Main Road Kundalahalli Gate, Bangalore, 560037, India
| | - Bettina Wabbels
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Frank G Holz
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Robert P Finger
- Department of Ophthalmology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Gheorghe CM, Purcărea VL, Gheorghe IR. Trick or treat: Social Media's dissemination power of ophthalmologic information in the pandemic context. Rom J Ophthalmol 2021; 65:125-129. [PMID: 34179576 PMCID: PMC8207867 DOI: 10.22336/rjo.2021.26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Social Media in the COVID-19 pandemic context has become a real dissemination medium of ophthalmology information for both physicians and health care consumers. This trend of sharing information has revealed new and innovative interventions in Ophthalmology such as teleophthalmology on Social Media by providing synchronous and asynchronous consultations, education, and prevention solutions as well as scientific research findings. This paper is a review of the current challenges and limitations faced by ophthalmologists and health care consumers during the COVID-19 pandemic.
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Affiliation(s)
- Consuela-Mădălina Gheorghe
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Victor Lorin Purcărea
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Iuliana-Raluca Gheorghe
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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15
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Mansoor H, Khan SA, Afghani T, Assir MZ, Ali M, Khan WA. Utility of teleconsultation in accessing eye care in a developing country during COVID-19 pandemic. PLoS One 2021; 16:e0245343. [PMID: 33444381 PMCID: PMC7808582 DOI: 10.1371/journal.pone.0245343] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/29/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the utility of teleconsultation in the provision of eye care services during the COVID-19 lockdown. Disparities in the consultation burden of sub-specialities and socio-demographic differences in teleconsultation utilization were also assessed. METHODS Al-Shifa Trust Eye Hospital Rawalpindi began audio and video teleconsultation using broadband telecommunication services during the lockdown. Patients' and consultations' data gathered during the first three weeks after the commencement of this programme were compared with data from the four weeks prior to lockdown. The weekly consultation ratio and overall consultation burden of sub-specialities were measured. Chi-Square tests of association determined the relationship between different variables (socioeconomic status and consultation characteristics) and consultation modality (on-site vs online). RESULTS In total, 17507 on-site consultations (4377/week) were conducted compared to 1431 teleconsultations (477/week), which maintained 10.89% of the weekly pre-lockdown eye care services. The post-lockdown teleconsultation programme saw a relatively higher percentage of service utility among female (47.09% vs 44.71%), younger-age (31.33±19.45 vs 41.25±23.32 years) and higher-socioeconomic-status (32.21% vs 0.30%) patients compared to pre-lockdown on-site consultations. The most common indication for teleconsultation was red-eye (16.70%). While cornea and glaucoma clinics maintained most of the pre-lockdown services (30.42% and 29% respectively), the highest dropout was seen in optometric and vitreoretinal services supporting only 5.54% and 8.28% of pre-lockdown services, respectively. CONCLUSION Digital initiatives could partially maintain eye care services during the lockdown. Focused strategies to improve teleconsultation utilization are required during the pandemic and beyond.
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Affiliation(s)
- Hassan Mansoor
- Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
- * E-mail: (WAK); (HM)
| | | | | | - Muhammad Zaman Assir
- Department of Medicine, Allama Iqbal Medical College, University of Health Sciences, Lahore, Pakistan
| | - Mahmood Ali
- Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Wajid Ali Khan
- Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
- * E-mail: (WAK); (HM)
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16
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Tognetto D, Brézin AP, Cummings AB, Malyugin BE, Evren Kemer O, Prieto I, Rejdak R, Teus MA, Törnblom R, Toro MD, Vinciguerra AL, Giglio R, De Giacinto C. Rethinking Elective Cataract Surgery Diagnostics, Assessments, and Tools after the COVID-19 Pandemic Experience and Beyond: Insights from the EUROCOVCAT Group. Diagnostics (Basel) 2020; 10:E1035. [PMID: 33276612 PMCID: PMC7761628 DOI: 10.3390/diagnostics10121035] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/21/2020] [Accepted: 12/01/2020] [Indexed: 01/08/2023] Open
Abstract
The progressive deterioration of the visual function in patients on waiting lists for cataract surgery has a negative impact on their quality of life, especially in the elderly population. Patient waiting times for cataract surgeries in many healthcare settings have increased recently due to the prolonged stop or slowdown of elective cataract surgery as a result of coronavirus disease 19 (COVID-19). The aim of this review is to highlight the impact of such a "de-prioritization" of cataract surgery and to summarize some critical issues and useful hints on how to reorganize cataract pathways, with a special focus on perioperative diagnostic tools during the recovery phase and beyond. The experiences of a group of surgeons originating from nine different countries, named the European COVID-19 Cataract Group (EUROCOVCAT), have been combined with the literature and recommendations from scientific ophthalmic societies and healthcare institutions. Key considerations for elective cataract surgery should include the reduction of the number of unnecessary visits and examinations, adoption of precautionary measures, and implementation of telemedicine instruments. New strategies should be adopted to provide an adequate level of assistance and to guarantee safety conditions. Flexibility will be the watchword and regular updates would be necessary following scientific insights and the development of the pandemic.
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Affiliation(s)
- Daniele Tognetto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
| | | | | | - Boris E. Malyugin
- S. Fyodorov Eye Microsurgery Federal State Institution, Russian Federation, 127486 Moscow, Russia;
| | - Ozlem Evren Kemer
- University of Health Sciences, Ankara City Hospital, 06800 Ankara, Turkey;
| | - Isabel Prieto
- Department of Ophthalmology, Fernando Fonseca Hospital, 2720-276 Amadora, Portugal;
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland;
| | - Miguel A. Teus
- Department of Ophthalmology, University of Alcalá, 28802 Madrid, Spain;
| | - Riikka Törnblom
- Department of Ophthalmology, TYKS Hospital, 20521 Turku, Finland;
| | - Mario D. Toro
- Department of General Ophthalmology, Medical University of Lublin, 20-079 Lublin, Poland;
- Faculty of Medical Sciences, Collegium Medicum, Cardinal Stefan Wyszyński University, 01-815 Warsaw, Poland
- Department of Ophthalmology, University Hospital of Zürich, University of Zürich, 8091 Zürich, Switzerland
| | - Alex L. Vinciguerra
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
| | - Rosa Giglio
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
| | - Chiara De Giacinto
- Eye Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, 34134 Trieste, Italy; (A.L.V.); (R.G.); (C.D.G.)
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17
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Yang M, Lo ACY, Lam WC. Smart phone apps every ophthalmologist should know about. Int J Ophthalmol 2020; 13:1329-1333. [PMID: 32821689 DOI: 10.18240/ijo.2020.08.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/09/2020] [Indexed: 12/28/2022] Open
Abstract
We are living in a mobile world, where the number of medical apps is surging in recent years. Over 320 000 healthcare apps are now available as shown in the latest research. The major function and potential of these apps vary, from assisting the learning and practice of clinicians as well as achieving better outcomes of patients to preventing eye diseases through the education of healthy individuals. However, based on the various features, ophthalmology apps nowadays contain a wide range of subjects and focus on different stakeholders in the ophthalmic practice, including but not limited to doctors, patients, and researchers. Here, we review special and advanced apps that ophthalmologists will find useful in their clinical practice.
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Affiliation(s)
- Ming Yang
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region 999077, China
| | - Amy Cheuk Yin Lo
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region 999077, China
| | - Wai Ching Lam
- Department of Ophthalmology, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong Special Administrative Region 999077, China
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18
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Jayadev C, Mahendradas P, Vinekar A, Kemmanu V, Gupta R, Pradhan ZS, D'Souza S, Aroor CD, Kaweri L, Shetty R, Honavar SG, Shetty B. Tele-consultations in the wake of COVID-19 - Suggested guidelines for clinical ophthalmology. Indian J Ophthalmol 2020; 68:1316-1327. [PMID: 32587157 PMCID: PMC7574118 DOI: 10.4103/ijo.ijo_1509_20] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
While telemedicine has been around for a few decades, it has taken great importance and prominence in recent times. With the fear of the virus being transmitted, patients and physicians across specialties are using consultation via a telephone call or video from the safety of their homes. Though tele-ophthalmology has been popular for screening, there are no clear guidelines on how to comprehensively manage patients seeking advice and treatment for a particular eye condition. Some major barriers to diagnosis and management are compromised detailed examination, no measurement of the visual acuity or intraocular pressure and a retinal evaluation not being feasible. Despite these limitations, we do need to help those patients who need immediate care or attention. Hence, this article has put together some guidelines to follow during such consultations. They are important and timely due to the medicolegal and financial implications.
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Affiliation(s)
- Chaitra Jayadev
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Padmamalini Mahendradas
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Anand Vinekar
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Vasudha Kemmanu
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Roshmi Gupta
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Zia S Pradhan
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Chaithra D Aroor
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Luci Kaweri
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Santosh G Honavar
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
| | - Bhujang Shetty
- Narayana Nethralaya Eye Institute, 121/C, Chord Road, Rajajinagar, Bengaluru, Karnataka, India
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19
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Incorporating Video Visits into Ophthalmology Practice: A Retrospective Analysis and Patient Survey to Assess Initial Experiences and Patient Acceptability at an Academic Eye Center. Ophthalmol Ther 2020; 9:549-562. [PMID: 32535837 PMCID: PMC7293175 DOI: 10.1007/s40123-020-00269-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has led to rapid adoption of teleophthalmology to deliver eyecare remotely. The purpose of our study was to assess the implementation and patient acceptability of video consultation for outpatient ophthalmic care at our institution. METHODS We conducted a retrospective, cross-sectional analysis and patient survey of adult patients who completed a virtual video visit at our institution from 18 March 18 through to 27 April 2020. All video visit encounters were assessed for patient characteristics, diagnoses, management, and follow-up outcomes. Patients were surveyed for their feedback on acceptability and utility of their virtual video consultation. RESULTS A total of 219 patients (mean age 55 years; range 21-89 years) completed 231 video visit encounters at our department over a 6-week period, of whom 118 were women (54%). About half of these encounters were acute visits (102 visits, 47%). The most common diagnosis of these visits was postoperative state (20 visits, 9% of the total), followed by conjunctivitis (16 visits, 7%), and keratitis (14 visits, 6%). The most common management decisions were medication prescription (102 visits, 46%) or reassurance (86 visits, 39%), while 17 video visit patients (8%) were escalated to an urgent, in-person evaluation. Ninety-two patients completed a follow-up survey (42% response rate), of whom 45 (49%) indicated that they might have delayed seeking care during this pandemic in the absence of a virtual video option. Seventy-two (78%) reported that they would consider participating in a video visit as an alternative to an office-based encounter in the future, and the overall video visit experience was rated highly, with a weighted mean Likert scale rating of 4.3 out of 5 (Cronbach's α = 0.88). CONCLUSION Virtual video visits may be used to manage a range of ophthalmic complaints. Patients participating in this survey found such video visits acceptable and timesaving, and the majority would consider using video consultations for future eyecare encounters.
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20
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Galiero R, Pafundi PC, Nevola R, Rinaldi L, Acierno C, Caturano A, Salvatore T, Adinolfi LE, Costagliola C, Sasso FC. The Importance of Telemedicine during COVID-19 Pandemic: A Focus on Diabetic Retinopathy. J Diabetes Res 2020; 2020:9036847. [PMID: 33123599 PMCID: PMC7584941 DOI: 10.1155/2020/9036847] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Recently, telemedicine has become remarkably important, due to increased deployment and development of digital technologies. National and international guidelines should consider its inclusion in their updates. During the COVID-19 pandemic, mandatory social distancing and the lack of effective treatments has made telemedicine the safest interactive system between patients, both infected and uninfected, and clinicians. A few potential evidence-based scenarios for the application of telemedicine have been hypothesized. In particular, its use in diabetes and complication monitoring has been remarkably increasing, due to the high risk of poor prognosis. New evidence and technological improvements in telemedicine application in diabetic retinopathy (DR) have demonstrated efficacy and usefulness in screening. Moreover, despite an initial increase for devices and training costs, teleophthalmology demonstrated a good cost-to-efficacy ratio; however, no national screening program has yet focused on DR prevention and diagnosis. Lack of data during the COVID-19 pandemic strongly limits the possibility of tracing the real management of the disease, which is only conceivable from past evidence in normal conditions. The pandemic further stressed the importance of remote monitoring. However, the deployment of device and digital application used to increase screening of individuals and monitor progression of retinal disease needs to be easily accessible to general practitioners.
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Affiliation(s)
- Raffaele Galiero
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia 80138 Naples, Italy
| | - Pia Clara Pafundi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia 80138 Naples, Italy
| | - Riccardo Nevola
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia 80138 Naples, Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia 80138 Naples, Italy
| | - Carlo Acierno
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia 80138 Naples, Italy
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia 80138 Naples, Italy
| | - Teresa Salvatore
- Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via de Crecchio 7, 80138 Naples, Italy
| | - Luigi Elio Adinolfi
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia 80138 Naples, Italy
| | - Ciro Costagliola
- Department of Medicine & Health Sciences “V. Tiberio”, University of Molise, Via F. De Sanctis, 1, 86100 Campobasso, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Piazza Luigi Miraglia 80138 Naples, Italy
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21
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Delgado MF, Abdelrahman AM, Terahi M, Miro Quesada Woll JJ, Gil-Carrasco F, Cook C, Benharbit M, Boisseau S, Chung E, Hadjiat Y, Gomes JAP. Management Of Glaucoma In Developing Countries: Challenges And Opportunities For Improvement. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:591-604. [PMID: 31632107 PMCID: PMC6776288 DOI: 10.2147/ceor.s218277] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022] Open
Abstract
Glaucoma is the leading cause of blindness in the developed and developing world. Not only is the clinical impact of this disease considerable, but associated economic and humanistic burdens - affecting patients, caregivers, and society - are substantial. Since glaucoma is an age-related disorder and populations in many developing countries are aging at a faster pace than in the developed world, increasing attention is being focused on ways to ameliorate the burdens of illness. In this paper, we examine the burdens of glaucoma with particular focus on developing countries, discuss some of the challenges that exist in delivering optimal glaucoma management within budget constraints, and bring into perspective how we could improve current healthcare systems, leverage technology, and strike an appropriate balance between cost and quality of care, thereby offering considerations to payors and policymakers in these countries that may result in longer-term cost savings, while concurrently striving to achieve the WHO Vision on the prevention of blindness and visual impairment.
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Affiliation(s)
| | | | - Malika Terahi
- Ophthalmology Department, CHU Nafissa Hammoud, Algiers, Algeria
| | | | - Felix Gil-Carrasco
- Glaucoma Department, Hospital Luis Sánchez Bulnes, Asociación para Evitar la Ceguera en México I.A.P, Mexico City, Mexico
| | - Colin Cook
- Division of Ophthalmology, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | | | | | - Ernestine Chung
- Mundipharma Singapore Holding Pte Limited, Singapore, Singapore
| | - Yacine Hadjiat
- Mundipharma Singapore Holding Pte Limited, Singapore, Singapore
| | - José AP Gomes
- Department of Ophthalmology and Visual Science, Federal University of São Paulo, São Paulo, Brazil
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22
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Smartphone-based fundus photography for screening of plus-disease retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol 2019; 257:2579-2585. [PMID: 31501929 DOI: 10.1007/s00417-019-04470-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/27/2019] [Accepted: 09/05/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Inadequate screening of treatment-warranted retinopathy of prematurity (ROP) can lead to devastating visual outcomes. Especially in resource-poor communities, the use of an affordable, portable, and easy to use smartphone-based non-contact fundus photography device may prove useful for screening for high-risk ROP. This study evaluates the feasibility of screening for high-risk ROP using a novel smartphone-based fundus photography device, RetinaScope. METHODS Retinal images were obtained using RetinaScope on a cohort of prematurely born infants during routine examinations for ROP. Images were reviewed by two masked graders who determined the image quality, the presence or absence of plus disease, and whether there was retinopathy that met predefined criteria for referral. The agreement between image-based assessments was compared to the gold standard indirect ophthalmoscopic assessment. RESULTS Fifty-four eyes of 27 infants were included. A wide-field fundus photograph was obtained using RetinaScope. Image quality was acceptable or excellent in 98% and 95% of cases. There was substantial agreement between the gold standard and photographic assessment of presence or absence of plus disease (Cohen's κ = 0.85). Intergrader agreement on the presence of any retinopathy in photographs was also high (κ = 0.92). CONCLUSIONS RetinaScope can capture digital retinal photographs of prematurely born infants with good image quality for grading of plus disease.
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23
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Artificial intelligence for diabetic retinopathy screening: a review. Eye (Lond) 2019; 34:451-460. [PMID: 31488886 DOI: 10.1038/s41433-019-0566-0] [Citation(s) in RCA: 138] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/19/2019] [Indexed: 12/14/2022] Open
Abstract
Diabetes is a global eye health issue. Given the rising in diabetes prevalence and ageing population, this poses significant challenge to perform diabetic retinopathy (DR) screening for these patients. Artificial intelligence (AI) using machine learning and deep learning have been adopted by various groups to develop automated DR detection algorithms. This article aims to describe the state-of-art AI DR screening technologies that have been described in the literature, some of which are already commercially available. All these technologies were designed using different training datasets and technical methodologies. Although many groups have published robust diagnostic performance of the AI algorithms for DR screening, future research is required to address several challenges, for examples medicolegal implications, ethics, and clinical deployment model in order to expedite the translation of these novel technologies into the healthcare setting.
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24
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Liu Y, Torres Diaz A, Benkert R. Scaling Up Teleophthalmology for Diabetic Eye Screening: Opportunities for Widespread Implementation in the USA. Curr Diab Rep 2019; 19:74. [PMID: 31375932 PMCID: PMC6934040 DOI: 10.1007/s11892-019-1187-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW We discuss opportunities to address key barriers to widespread implementation of teleophthalmology programs for diabetic eye screening in the United States (U.S.). RECENT FINDINGS Teleophthalmology is an evidence-based form of diabetic eye screening. This technology has been proven to substantially increase diabetic eye screening rates and decrease blindness. However, teleophthalmology implementation remains limited among U.S. health systems. Major barriers include financial concerns as well as limited utilization by providers, clinical staff, and patients. Possible interventions include increasingly affordable camera technology, demonstration of financially sustainable billing models, and engaging key stakeholders. Significant opportunities exist to overcome barriers to scale up and promote widespread implementation of teleophthalmology in the USA. Further development of methods to sustain effective increases in diabetic eye screening rates using this technology is needed. In addition, the demonstration of cost-effectiveness in a variety of billing models should be investigated to facilitate widespread implementation of teleophthalmology in U.S. health systems.
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Affiliation(s)
- Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, 2870 University Ave, Ste 206, Madison, WI, 53705, USA.
| | - Alejandra Torres Diaz
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, 2870 University Ave, Ste 206, Madison, WI, 53705, USA
| | - Ramsey Benkert
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, 2870 University Ave, Ste 206, Madison, WI, 53705, USA
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25
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Use of a Tablet Attachment in Teleophthalmology for Real-Time Video Transmission from Rural Vision Centers in a Three-Tier Eye Care Network in India: eyeSmart Cyclops. Int J Telemed Appl 2019; 2019:5683085. [PMID: 31057606 PMCID: PMC6463610 DOI: 10.1155/2019/5683085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/24/2019] [Indexed: 12/23/2022] Open
Abstract
Purpose This study describes the development of an attachment for a smart tablet to stream live video information of an eye examination through the slit lamp. Methods A tablet attachment was developed that enables the live streaming of video from the slit lamp from the rural vision centers of the LVPEI network. A video streaming solution like Skype Lite was used to transmit the same. The eyeSmart app was utilized for the documentation of the clinical information of the patients. Results A tablet attachment of eyeSmart Cyclops was developed and piloted in 3 vision centers of the LVPEI network. Conclusion The use of real-time video transmission illustrates a novel teleophthalmology solution in low resource settings to screen rural populations. The ability to transmit live video enables gathering more information than static images.
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26
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Annoh R, Patel S, Beck D, Ellis H, Dhillon B, Sanders R. Digital ophthalmology in Scotland: benefits to patient care and education. Clin Ophthalmol 2019; 13:277-286. [PMID: 30799914 PMCID: PMC6371934 DOI: 10.2147/opth.s185186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Tackling visual impairment remains an important public health issue. Due to limited resources and the increasing demand on hospital eye services (HES), delivery of quality eye care within the community is essential. Training of clinical ophthalmic specialists and allied health-care professionals in the detection and management of common eye conditions can thus help to reduce the burden of eye disease and improve prognostic outcomes. Digital imaging has become a useful tool in facilitating eye-care delivery in both the community and hospital setting. In the last decade, the advent of electronic image exchange via a centralized referral unit in Scotland has revolutionized screening for ophthalmic disease, referrals, and shared care between community and HES clinicians. A government-led initiative known as the Scottish Eyecare Integration Project introduced electronic transfer of digital images within referrals from community optometrists to HES, which greatly reduced outpatient waiting times and improved patient satisfaction. The catalogue of live clinical information and digital images that resulted from the project led to the creation of a virtual learning platform through the University of Edinburgh. Participating professionals involved in eye care have interactive discussions about common eye conditions by sharing digital images of cases and investigations on a global online platform. This has received worldwide attention and inspired the creation of other university courses, e-learning platforms in eye-health education, and shared-care schemes in the screening of eye disease. We show that digital ophthalmology plays a vital role in the integration of community and HES partnership in delivery of patient care and in facilitating eye-health education to a global audience.
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Affiliation(s)
| | - Sirjhun Patel
- Ophthalmology Department, Ninewells Hospital, Dundee, UK
| | - Daniel Beck
- Princess Alexandra Eye Pavilion, Edinburgh, UK,
| | - Heather Ellis
- Ophthalmology Department, Lauriston Building, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | - Bal Dhillon
- Princess Alexandra Eye Pavilion, Edinburgh, UK,
- University of Edinburgh, Edinburgh, UK
| | - Roshini Sanders
- University of Edinburgh, Edinburgh, UK
- Queen Margaret Hospital, Dunfermline, UK
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27
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Saeed E, Szymkowski M, Saeed K, Mariak Z. An Approach to Automatic Hard Exudate Detection in Retina Color Images by a Telemedicine System Based on the d-Eye Sensor and Image Processing Algorithms. SENSORS 2019; 19:s19030695. [PMID: 30744032 PMCID: PMC6387053 DOI: 10.3390/s19030695] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 11/16/2022]
Abstract
Hard exudates are one of the most characteristic and dangerous signs of diabetic retinopathy. They can be marked during the routine ophthalmological examination and seen in color fundus photographs (i.e., using a fundus camera). The purpose of this paper is to introduce an algorithm that can extract pathological changes (i.e., hard exudates) in diabetic retinopathy. This was a retrospective, nonrandomized study. A total of 100 photos were included in the analysis—50 sick and 50 normal eyes. Small lesions in diabetic retinopathy could be automatically diagnosed by the system with an accuracy of 98%. During the experiments, the authors used classical image processing methods such as binarization or median filtration, and data was read from the d-Eye sensor. Sixty-seven patients (39 females and 28 males with ages ranging between 50 and 64) were examined. The results have shown that the proposed solution accuracy level equals 98%. Moreover, the algorithm returns correct classification decisions for high quality images and low quality samples. Furthermore, we consider taking retina photos using mobile phones rather than fundus cameras, which is more practical. The paper presents an innovative approach. The results are introduced and the algorithm is described.
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Affiliation(s)
- Emil Saeed
- Department of Ophthalmology, Faculty of Medicine, Medical University of Bialystok, 24A Curie-Sklodowskiej Street, 15-276 Bialystok, Poland.
| | - Maciej Szymkowski
- Bialystok University of Technology, Faculty of Computer Science, 45A Wiejska Street,15-351 Białystok, Poland.
| | - Khalid Saeed
- Bialystok University of Technology, Faculty of Computer Science, 45A Wiejska Street,15-351 Białystok, Poland.
| | - Zofia Mariak
- Department of Ophthalmology, Faculty of Medicine, Medical University of Bialystok, 24A Curie-Sklodowskiej Street, 15-276 Bialystok, Poland.
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