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Atkin C, Crosby B, Dunn K, Price G, Marston E, Crawford C, O’Hara M, Morgan C, Levermore M, Gallier S, Modhwadia S, Attwood J, Perks S, Denniston AK, Gkoutos G, Dormer R, Rosser A, Ignatowicz A, Fanning H, Sapey E. Perceptions of anonymised data use and awareness of the NHS data opt-out amongst patients, carers and healthcare staff. Res Involv Engagem 2021; 7:40. [PMID: 34127076 PMCID: PMC8201435 DOI: 10.1186/s40900-021-00281-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/10/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND England operates a National Data Opt-Out (NDOO) for the secondary use of confidential health data for research and planning. We hypothesised that public awareness and support for the secondary use of health data and the NDOO would vary by participant demography and healthcare experience. We explored patient/public awareness and perceptions of secondary data use, grouping potential researchers into National Health Service (NHS), academia or commercial. We assessed awareness of the NDOO system amongst patients, carers, healthcare staff and the public. We co-developed recommendations to consider when sharing unconsented health data for research. METHODS A patient and public engagement program, co-created and including patient and public workshops, questionnaires and discussion groups regarding anonymised health data use. RESULTS There were 350 participants in total. Central concerns for health data use included unauthorised data re-use, the potential for discrimination and data sharing without patient benefit. 94% of respondents were happy for their data to be used for NHS research, 85% for academic research and 68% by health companies, but less than 50% for non-healthcare companies and opinions varied with demography and participant group. Questionnaires showed that knowledge of the NDOO was low, with 32% of all respondents, 53% of all NHS staff and 29% of all patients aware of the NDOO. Recommendations to guide unconsented secondary health data use included that health data use should benefit patients; data sharing decisions should involve patients/public. That data should remain in close proximity to health services with the principles of data minimisation applied. Further, that there should be transparency in secondary health data use, including publicly available lists of projects, summaries and benefits. Finally, organisations involved in data access decisions should participate in programmes to increase knowledge of the NDOO, to ensure public members were making informed choices about their own data. CONCLUSION The majority of participants in this study reported that the use of healthcare data for secondary purposes was acceptable when accessed by NHS. Academic and health-focused companies. However, awareness was limited, including of the NDOO. Further development of publicly-agreed recommendations for secondary health data use may improve both awareness and confidence in secondary health data use.
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Affiliation(s)
- C. Atkin
- PIONEER Hub in Acute Care, Institute of Inflammation and Ageing, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - B. Crosby
- PIONEER HDR-UK Data Hub in Acute Care, Institute of Inflammation and Ageing, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - K. Dunn
- HDR-UK Midlands Physical Site, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - G. Price
- Patient Involvement and Engagement Lead, PIONEER, London, UK
| | - E. Marston
- Research Support Services, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - C. Crawford
- Research and Development, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - M. O’Hara
- University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - C. Morgan
- Public author, B15 2GW Birmingham, UK
| | - M. Levermore
- Medical Devices Technology International Limited (MDTi), The KaCe Building, Victoria Passage, Wolverhampton, West Midlands WV1 4LG UK
- Health, Education and Life Sciences, Birmingham City University, Birmingham, West Midlands UK
| | - S. Gallier
- Technical Director, PIONEER HDR-UK Data Hub in Acute Care, Institute of Inflammation and Ageing, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - S. Modhwadia
- PIONEER HDR-UK Data Hub in Acute Care, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - J. Attwood
- Informatics, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - S. Perks
- Informatics, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - A. K. Denniston
- Director of INSIGHT - the Health Data Research Hub for Eye Health, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, B15 2GW UK
- Centre for Regulatory Science and Innovation, Birmingham Health Partners, Birmingham, B15 2GW UK
- NIHR Biomedical Research Centre (Moorfields Eye Hospital NHS Foundation Trust and University College London), Birmingham, UK
| | - G. Gkoutos
- Alan Turing Institute, HDR-UK Associated Researcher, Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - R. Dormer
- Insignia Medical Systems Limited, Paterson House, Hatch Warren Lane, Basingstoke, Hampshire, RG22 4RA UK
| | - A. Rosser
- West Midlands Ambulance Service Foundation Trust, Millennium Point, Waterfront Business Park, Waterfront Way, Brierley Hill, West Midlands, DY5 1LX UK
| | - A. Ignatowicz
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - H. Fanning
- Research and Development, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW UK
| | - E. Sapey
- PIONEER, HDR-UK Health Data Research Hub in Acute Care, Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2GW UK
- Department of Acute Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW UK
- NIHR CRF, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW UK
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Courtie E, Veenith T, Logan A, Denniston AK, Blanch RJ. Retinal blood flow in critical illness and systemic disease: a review. Ann Intensive Care 2020; 10:152. [PMID: 33184724 PMCID: PMC7661622 DOI: 10.1186/s13613-020-00768-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Assessment and maintenance of end-organ perfusion are key to resuscitation in critical illness, although there are limited direct methods or proxy measures to assess cerebral perfusion. Novel non-invasive methods of monitoring microcirculation in critically ill patients offer the potential for real-time updates to improve patient outcomes. MAIN BODY Parallel mechanisms autoregulate retinal and cerebral microcirculation to maintain blood flow to meet metabolic demands across a range of perfusion pressures. Cerebral blood flow (CBF) is reduced and autoregulation impaired in sepsis, but current methods to image CBF do not reproducibly assess the microcirculation. Peripheral microcirculatory blood flow may be imaged in sublingual and conjunctival mucosa and is impaired in sepsis. Retinal microcirculation can be directly imaged by optical coherence tomography angiography (OCTA) during perfusion-deficit states such as sepsis, and other systemic haemodynamic disturbances such as acute coronary syndrome, and systemic inflammatory conditions such as inflammatory bowel disease. CONCLUSION Monitoring microcirculatory flow offers the potential to enhance monitoring in the care of critically ill patients, and imaging retinal blood flow during critical illness offers a potential biomarker for cerebral microcirculatory perfusion.
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Affiliation(s)
- E Courtie
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - T Veenith
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - A Logan
- Axolotl Consulting Ltd, Droitwich, WR9 0JS, Worcestershire, UK
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7HL, UK
| | - A K Denniston
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
- Centre for Rare Diseases, Institute of Translational Medicine, Birmingham Health Partners, Birmingham, UK
| | - R J Blanch
- Neuroscience and Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Ophthalmology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK.
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3
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Coric D, Ometto G, Montesano G, Keane PA, Balk LJ, Uitdehaag BMJ, Petzold A, Crabb DP, Denniston AK. Objective quantification of vitreous haze on optical coherence tomography scans: no evidence for relationship between uveitis and inflammation in multiple sclerosis. Eur J Neurol 2019; 27:144-e3. [PMID: 31342606 PMCID: PMC6916624 DOI: 10.1111/ene.14048] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/22/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE The occurrence of intermediate uveitis, which is characterized by the presence of vitreous haze (VH), in patients with multiple sclerosis (MS) may be a sign of coexistent inflammatory central nervous system (CNS) disease activity. Using an automated algorithm to quantify VH on optical coherence tomography (OCT) scans, the aim was to investigate whether VH in MS patients is associated with signs of inflammatory CNS disease activity. METHODS Vitreous haze was quantified on OCT macular volume scans of 290 MS patients and 85 healthy controls (HCs). The relationship between VH and clinical, retinal OCT and magnetic resonance imaging parameters of inflammatory disease activity was investigated using generalized estimating equations. RESULTS Mean VH scores did not differ between patients and HCs (P = 0.629). Six patients (2.1%) showed values higher than the highest of the controls by HCs. VH scores did not differ between the different disease types or between eyes with and without a history of optic neuritis (P = 0.132). VH was not associated with inner nuclear layer volume on OCT (P = 0.233), cerebral T2 lesion load on magnetic resonance imaging (P = 0.416) or the development of new relapses (P = 0.205). CONCLUSION In this study, OCT-based automated VH estimation did not detect increased vitreous inflammation in MS patients compared to HCs and did not find an association with CNS inflammatory burden.
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Affiliation(s)
- D Coric
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Dutch Expertise Center for Neuro-ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands
| | - G Ometto
- Optometry and Visual Sciences, City, University of London, London, UK
| | - G Montesano
- Optometry and Visual Sciences, City, University of London, London, UK.,NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - P A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - L J Balk
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Dutch Expertise Center for Neuro-ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands
| | - B M J Uitdehaag
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - A Petzold
- Department of Neurology, MS Center Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Dutch Expertise Center for Neuro-ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands.,Moorfields Eye Hospital, London, UK.,National Hospital for Neurology and Neurosurgery, London, UK
| | - D P Crabb
- Optometry and Visual Sciences, City, University of London, London, UK
| | - A K Denniston
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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Gilmour-White JA, Picton A, Blaikie A, Denniston AK, Blanch R, Coleman J, Murray PI. Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education. BMC Med Educ 2019; 19:201. [PMID: 31196068 PMCID: PMC6567496 DOI: 10.1186/s12909-019-1644-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/31/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Direct ophthalmoscopy (DO) is an essential skill for medical graduates but there are multiple barriers to learning this. Medical students and junior doctors typically lack confidence in DO. Most students do not own an ophthalmoscope and learn via ward devices that vary in design and usability. The Arclight ophthalmoscope (AO) is an easy to use, low-cost and portable device that could help address device access. This study aimed to assess the impact of personal ownership of an AO on DO skill acquisition and competency amongst medical students in the clinical environment. METHODS Method comparison study with 42 medical students randomised to either traditional device ophthalmoscope (TDO) control or AO intervention group during an 18-week medical placement. Three objective assessments of DO competency were performed at the beginning and end of the placement: vertical cup to disc ratio (VCDR) measurement, fundus photo multiple-choice questions (F-MCQ) and model slide examination (MSE). DO examinations performed during the placement were recorded via an electronic logbook. RESULTS Students in both groups recorded a median number of six examinations each during an eighteen-week placement. There was no statistically significant difference between the groups in any of the objective assessment measures (VCDR p = 0.561, MCQ p = 0.872, Model p = 0.772). Both groups demonstrated a minor improvement in VCDR measurement but a negative performance change in F-MCQ and MSE assessments. CONCLUSIONS Students do not practice ophthalmoscopy often, even with constant access to their own portable device. The lack of significant difference between the groups suggests that device access alone is not the major factor affecting frequency of DO performance and consequent skill acquisition. Improving student engagement with ophthalmoscopy will require a more wide-ranging approach.
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Affiliation(s)
| | - A. Picton
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A. Blaikie
- Global Health Implementation Team, School of Medicine, University of St Andrews, Scotland, UK
| | - A. K. Denniston
- University Hospitals Birmingham NHSFT, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - R. Blanch
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - J. Coleman
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - P. I. Murray
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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5
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Tan ACS, Tan GS, Denniston AK, Keane PA, Ang M, Milea D, Chakravarthy U, Cheung CMG. An overview of the clinical applications of optical coherence tomography angiography. Eye (Lond) 2018; 32:262-286. [PMID: 28885606 PMCID: PMC5811700 DOI: 10.1038/eye.2017.181] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/15/2017] [Indexed: 12/15/2022] Open
Abstract
Optical coherence tomography angiography (OCTA) has emerged as a novel, non-invasive imaging modality that allows the detailed study of flow within the vascular structures of the eye. Compared to conventional dye angiography, OCTA can produce more detailed, higher resolution images of the vasculature without the added risk of dye injection. In our review, we discuss the advantages and disadvantages of this new technology in comparison to conventional dye angiography. We provide an overview of the current OCTA technology available, compare the various commercial OCTA machines technical specifications and discuss some future software improvements. An approach to the interpretation of OCTA images by correlating images to other multimodal imaging with attention to identifying potential artefacts will be outlined and may be useful to ophthalmologists, particularly those who are currently still unfamiliar with this new technology. This review is based on a search of peer-reviewed published papers relevant to OCTA according to our current knowledge, up to January 2017, available on the PubMed database. Currently, many of the published studies have focused on OCTA imaging of the retina, in particular, the use of OCTA in the diagnosis and management of common retinal diseases such as age-related macular degeneration and retinal vascular diseases. In addition, we describe clinical applications for OCTA imaging in inflammatory diseases, optic nerve diseases and anterior segment diseases. This review is based on both the current literature and the clinical experience of our individual authors, with an emphasis on the clinical applications of this imaging technology.
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Affiliation(s)
- A C S Tan
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - G S Tan
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - A K Denniston
- Department of Ophthalmology, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - P A Keane
- National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - M Ang
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - D Milea
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - U Chakravarthy
- Department of Ophthalmology, Queen's University of Belfast, Royal Victoria Hospital, Belfast, Northern Ireland
| | - C M G Cheung
- Singapore National Eye Center, Singapore Eye Research Institute, Singapore, Singapore
- Singapore Eye Research Institute, Singapore Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Montesano G, Way CM, Ometto G, Ibrahim H, Jones PR, Carmichael R, Liu X, Aslam T, Keane PA, Crabb DP, Denniston AK. Optimizing OCT acquisition parameters for assessments of vitreous haze for application in uveitis. Sci Rep 2018; 8:1648. [PMID: 29374239 PMCID: PMC5785990 DOI: 10.1038/s41598-018-20092-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 01/12/2018] [Indexed: 12/19/2022] Open
Abstract
Detection and evaluation of inflammatory activity in uveitis is essential to the management of the condition, and yet continues to be largely dependent on subjective clinical measures. Optical coherence tomography (OCT) measurement of vitreous activity is an alternative to clinical vitreous haze scoring and has passed a number of early validation studies. In this study we aimed to evaluate the impact of ‘operator factors’ on the variability of the technique as part of the validation process, and to help evaluate its suitability for ‘real world’ use. Vitreous haze index was calculated as a ratio between the reflectivity of the vitreous and of the outer retina in each scan. Different scanning conditions were tested and their effect on the measurement is reported. Our results show that the ‘quantitative imaging’ technique of OCT-measured vitreous activity had good reliability in normal subjects under a range of ‘real world’ conditions, such as when the operator changes the averaging value. The technique was however vulnerable to highly inaccurate focussing or abnormal downward displacement of the image. OCT-based quantification of vitreous activity is a promising alternative to current subjective clinical estimates, with sufficient ‘tolerance’ to be used in routine clinical practice as well as clinical trials.
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Affiliation(s)
- G Montesano
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
| | - C M Way
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - G Ometto
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
| | - H Ibrahim
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - P R Jones
- City, University of London, Optometry and Visual Sciences, London, United Kingdom.,NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - R Carmichael
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - X Liu
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom.,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - T Aslam
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Faculty of Medical and Human Sciences, University of Manchester, Manchester, United Kingdom.,School of Built Environment, Heriot-Watt University, Edinburgh, United Kingdom
| | - P A Keane
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom
| | - D P Crabb
- City, University of London, Optometry and Visual Sciences, London, United Kingdom
| | - A K Denniston
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom. .,Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom. .,NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, United Kingdom.
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7
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Mollan SP, Keane PA, Denniston AK. The use of transdermal optical coherence tomography to image the superficial temporal arteries. Eye (Lond) 2017; 31:157-160. [PMID: 27740619 PMCID: PMC5233932 DOI: 10.1038/eye.2016.206] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 07/14/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeThe diagnosis of Giant Cell Arteritis (GCA) is an area of major challenge. This is the first reported use of the directed use of transdermal optical coherence tomography (OCT) to image the superficial temporal artery (STA).MethodsThis proof of concept study used a commercially available transdermal OCT instrument to identify and image the STA in eight patients (suspected GCA, confirmed GCA, and in healthy controls). Three cases are presented to demonstrate the preliminary imaging findings.ResultsIn all eight cases the STA was identified. Imaging findings from three cases are presented. A hyper-reflective signal was seen, which distinguishes the artery from vein. In two cases, a ratio of band thickness (BT) to arterial lumen diameter (ALD) could be calculated (BT : ALD ratio) where the whole circumference of the artery was imaged.DiscussionUsing dermal OCT to image the temporal arteries is a novel concept. With ongoing advances in resolution, penetration, and blood flow detection; this non-invasive technology warrants further investigation to determine its role in Giant Cell Arteritis.
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Affiliation(s)
- S P Mollan
- Birmingham Neuro-Ophthalmology Unit, Department of Ophthalmology, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
- Neurotrauma and Neurodegeneration, School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, The Medical School, The University of Birmingham, Birmingham, UK
| | - P A Keane
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, London, UK
- University College London, Institute of Ophthalmology, London, UK
| | - A K Denniston
- University College London, Institute of Ophthalmology, London, UK
- Centre for Translational Inflammation Research, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Ophthalmology, University Hospitals Birmingham NHS Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
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8
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Hickman RA, Denniston AK, Yee CS, Toescu V, Murray PI, Gordon C. Bilateral retinal vasculitis in a patient with systemic lupus erythematosus and its remission with rituximab therapy. Lupus 2009; 19:327-9. [PMID: 19900982 DOI: 10.1177/0961203309347332] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Severe retinal vasculitis is a rare, but potentially blinding, complication of patients with systemic lupus erythematosus (SLE). We describe here the first reported case of treating severe bilateral SLE-associated retinal vasculitis with the anti-CD20 monoclonal antibody rituximab, a drug which has established its role in rheumatoid arthritis and has shown promise in case series for the treatment of severe SLE that is unresponsive to other therapies. This case suggests that rituximab-induced B-cell depletion may provide an important new therapeutic option for refractory cases of this devastating ocular complication.
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Affiliation(s)
- R A Hickman
- Rheumatology Research Group, University of Birmingham, Edgbaston, Birmingham, UK
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Abstract
Ocular manifestations of lupus are fairly common, may be the presenting feature of the disease and can be sight-threatening. Almost any part of the eye and visual pathway can be affected by inflammatory or thrombotic processes. Ocular pain and visual impairment require urgent assessment by an ophthalmologist. Infection should be excluded. Optic neuritis and ischaemic optic neuropathy may be difficult to distinguish. Scleritis and severe retinopathy require systemic immunosuppression but episcleritis, anterior uveitis and dry eyes can usually be managed with local eye drops. Vaso-occlusive disease, particularly in the presence of antiphospholipid antibodies, requires treatment with anticoagulation and proliferative retinopathy is treated with laser therapy. Hydroxychloroquine rarely causes ocular toxicity at doses under 6.5 mg/kg/day. When this has occurred, it has been associated with more than 5 years of drug exposure.
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Affiliation(s)
- R R Sivaraj
- Academic Unit of Ophthalmology, Division of Immunity and Infection, University of Birmingham, UK
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