Implementation and pilot data on diabetic retinopathy in a teleophthalmology program at a multispecialty primary care clinic

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To report on the implementation and initial pilot data of diabetic retinopathy (DR) identified using a validated telemedicine program for DR in a multispecialty primary care clinic.<br /><strong>METHODS:</strong> This was a retrospective, cross-sectional pilot survey of diabetic patients imaged for the first time at the telemedicine program of The Medical City from November 26, 2012 to August 31, 2013. The retinal images were obtained following the validated program of the Joslin Vision Network nonmydria. tic fundus photography for DR evaluation. These were evaluated by 4 retina specialists using a standardized protocol to assess for diabetic retinal disease and the presence of other retinal findings. The findings were recorded on customized electronic templates.<br /><strong>RESULTS:</strong> Seven hundred seventy-six (776) eyes of 388 patients were evaluated using the telemedicine program. The prevalence of DR was 28.2% (219 eyes), with 25.1% (195 eyes) having nonproliferative DR (NPDR). 14.2% 1110 eyes] had mild, 8.2% [64 eyes] moderate, 2.2% [17 eyes] severe, and 0.5% [4 eyes] very severe NPDR. 3.1% (24 eyes) had proliferative DR (PDR), of which 45.8% (11 eyes) had high-risk characteristics. The ungradable rate with selective mydriasis was 1.80% (14 eyes). The rate of referable DR (moderate NPDR or worse, any level of diabetic macular edema, or ungradable images) was 21.90% (170 eyes).<br /><strong>CONCLUSION:</strong> In the primary care setting, teleophthalmology can effectively identify patients with diabetic retinal complications and potentially refer these patients to appropriate levels of eye care. Retinopathy was present in over 28% of patients evaluated and over 21% had referable disease that may potentially progress to vision loss. Teleophthalmology for DR in this setting allows early detection of potentially sight threatening disease and may prevent visual loss and complications.</p>

Baseline macular pigment optical density among Filipinos with age-related macular degeneration

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To compare the macular pigment optical density (MPOD) among Filipinos with and without age¬related macular degeneration (AMD).</p> <p style="text-align: justify;"><strong>METHODS:</strong> Consecutive patients with AMD and without posterior segment disease were recruited into the study Baseline MPOD measurements using an autofluorescence spectrometer were obtained. MPOD in the 0.5 degree retinal eccentricity and the average of 3 measurements (MPOD Max) was the primary outcome measure.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> 120 patients, aged 50 to 80 years, were included into 3 groups: group 1 (n=40) without retinal disease, group 2 (n=40) with non-neovascular AMD, and group 3 (n=40) with neovascular AMD. The mean baseline MPOD were: 0.382 ± 0.10 DU for group 1, 0.333 ± 0.07 DU for group 2, and 0.283 ± 0.07 DU for group 3. Significant differences were present comparing the MPOD values of the 3 groups.</p> <p style="text-align: justify;"><strong>CONCLUSION: </strong>Eyes without retinal disease had higher MPOD than those with early non-neovascular or neovascular AMD.</p>

The pressor and mydriatic effects of tropicamide-phenylephrine combination, plain tropicamide, and plain phenylephrine: A randomized, controlled trial

OBJECTIVE: To evaluate the pressor and mydriatic effects of different concentrations of tropic amide and phenylephrine eye drops: tropicamide 0.5 % (Mydriacyl), phenylephrine hydrochloride 2.5 % (Mydfrin), tropicamide-phenylephrine combination 0.5 %/0.5%(Sanmyd-P), and self-prepared mixture (1:1 dilution) of commercially prepared tropicamide 0.5 percent and phenylephrine 2.5 %. METHODS: A prospective, randomized, double-blind study was carried out involving 160 eyes of 80 patients who were randomly assigned into four groups to receive phenylephrine + tropicamide 0.5 percent/0.5% (Group A), tropicamide + phenylephrine 0.2 %/1.25 (Group B), tropicamide 0.5 % (Group C), or phenylephrine 2.5% (Group D). The main outcome measures were systolic, diastolic, and mean arterial pressures; pulse rate; and horizontal pupillary diameter determined at 10-, 20-, 30-, 45-, and 60-minute intervals postinstillation. Repeated measures analysis of variance and Tukey's honestly significant difference were used to analyze outcomes. RESULTS: There was no significant increase in the systolic and diastolic blood pressure within each group and between groups. The mean increase or decrease in heart rate from baseline did not show a significant difference. Tropicamide-phenylephrine 0.5 %/0.5 % (Group A) and tropicamide-phenylephrine 0.25 %/1.25 % (Group B) yielded the highest mean increase in pupil size across time. CONCLUSION: Tropicamide-phenylephrine 0.5%/0.5 % and tropicamide-phenylephrine 0.25%/1.25% attained better dilation per unit time than the other treatment groups. No significant effect on blood pressure and heart rate was seen in all groups.

Causes of failure of pneumatic retinopexy

Methods: A retrospective review of pneumatic retinopexy procedures performed at the UP-PGH from January 1996 to December 2002 was undertaken. Seventeen cases were analyzed as to preoperative and intraoperative variables: age; sex; preoperative visual acuity; presence of proliferative vitreoretinopathy(PVR); extent of retinal detachment; presence of macular detachment; presence, number, and type of lattice degeneration; previous cataract surgery; surgeon factor; and intraoperative use of cryotherapy. Two-tailed Fishers exact test and Chi square test were used in the analysis of statistical significance. Results: The following variables were shown to be significantly correlated with failure: eyes with breaks outside the 11-1 oclock meridians (p=0.02), eyes with less than or equal to 3 quadrants of retinal detachment (p=0.05), and preoperative visual acuity worse than 5/60 (p0.100). Conclusion: Failure in eyes with retinal breaks outside the 11-1 oclock meridians suggested poor patient compliance with regard to postoperative posture. In eyes with less than or equal to three quadrants of detachment, failure may ensue as a result of spillover of subretinal fluid to uninvolved quadrants. Future success with pneumatic retinopexy will rely ultimately on careful patient selection, surgeon familiarity with the technique, and patient cooperation.

Study on the application of general body ultrasound for ophthalmic use

In the Philippine setting, hospitals, particularly government, provincial and regional hospitals are equipped with general body scanners. Ophthalmic ultrasound particularly the ocular B-scan ultrasound is not available. Can a B-scan general body ultrasound be used for visualizing gross intra-ocular disease? It is the objective of this study to describe the usefulness of a 7.5MHz general body ultrasound in detecting and supporting diagnosis for specific intra-ocular conditions. After a thorough history and physical examination, a total of 11 eyes were examined with diagnosis of retinal detachments, vitreous hemorrhage, dislocated lens, intra-ocular foreign body and a normal eye for comparison. All examinations were done by only one senior radiology resident. Results obtained from the 7.5MHz transducer were compared to either an ophthalmic B-scan ultrasound, X-rays or as reported by direct visualization. The result of this study is encouraging because the 7.5MHz B-scan general body ultrasound transducer was able to help in the diagnosis of intraocular diseases and intraocular foreign bodies especially when the posterior pole was not visible.