Advancements in the application of adaptive optics-based retinal imaging technology / 国际眼科杂志(Guoji Yanke Zazhi)

Adaptive optics(AO)is a technique used to optimize the functionality of optical systems through the reduction of wavefront distortion and optical aberrations. AO-based retinal imaging reduces the occurrence of optical aberrations in the refractive system, consequently improving the resolution and overall quality of retinal imaging. As a result, AO-based retinal imaging has potential wide-ranging application in ophthalmology. A combination of AO, fundus camera, scanning laser ophthalmoscope, optical coherence tomography technique and optical coherence tomography angiography, can be applied to observe the distribution, morphology and function of retinal cone cells in the healthy retinal, and to comprehend the shape and perfusion of retinal vessels in the fine vascular layer. With this technique, it can also possible to perform qualitative and quantitative analysis of the number and shape of cells in the ocular fundus, the cribriform plate, and the microscopic structures of the retinal microvascular system and nerve tissue. It can be expected as a novel tool for the early diagnosis, follow-up of therapy effects, and identification of progression of ophthalmic diseases such as diabetic retinopathy, age-related macular degeneration, glaucoma and hereditary retinal diseases.

Clinical profile and distribution of peripheral retinal changes in myopic population in a hospital-based study in North India

Purpose: To evaluate the prevalence of different types of peripheral retinal changes in a myopic population in North India and correlate them with axial length. Methods: This cross?sectional, hospital?based survey included 600 eyes of 300 myopic individuals, aged between 10 and 40 years, attending the outdoor ophthalmology clinic of a tertiary eye care hospital in North India were examined from July 2019 to July 2020. They were divided into mild, moderate, high, and severe myopia according to the spherical equivalent of refraction. Axial length was recorded. Peripheral retinal changes were examined by scleral indentation binocular indirect ophthalmoscopy. Standardized findings considered with their fundus location were lattice degeneration, white without pressure and white with pressure, snail?track degenerations, peripheral chorioretinal atrophy, retinal holes, tears, and detachment. The study was approved by the institutional ethics committee, and all participants provided informed consent. Results: Peripheral retinal degenerations were found in almost half (53%) of all myopes included in the study. The most common peripheral retinal degeneration found was lattice degeneration, followed by white without pressure, white with pressure, and chorioretinal atrophy. Most of the peripheral retinal degenerations were seen in the temporal quadrant of the fundus, either superotemporal or inferotemporal. There was a significant positive association between the prevalence of peripheral retinal degeneration with age, increased axial length, and severity of myopia. Conclusion: The results of our study indicate the necessity for careful peripheral fundus examinations of all myopes, irrespective of age and degree of myopia, for early diagnosis and better management of visual?threatening complications like retinal detachment.

Clinical and imaging features of idiopathic intracranial hypertension / 中南大学学报(医学版)

OBJECTIVES@#Idiopathic intracranial hypertension (IIH) is a syndrome that excludes secondary causes such as intracranial space-occupying lesion, hydrocephalus, cerebrovascular disease, and hypoxic ischemic encephalopathy. If not be treated promptly and effectively, IIH can cause severe, permanent vision disability and intractable, disabling headache. This study aims to explore the clinical and image features for IIH, to help clinicians to understand this disease, increase the diagnose rate, and improve the outcomes of patients.@*METHODS@#We retrospectively analyzed 15 cases of IIH that were admitted to Xiangya Hospital, Central South University, during January 2015 to September 2020. The diagnosis of IIH was based on the updated modified Dandy criteria. We analyzed clinical data of patients and did statistical analysis, including age, gender, height, weight, medical history, physical examination, auxiliary examination, treatment and outcome.@*RESULTS@#There were 10 females and 5 males. Female patients were 22 to 42 years old with median age of 39.5. Male patients were 27 to 52 years old with the median age of 44.0. The BMI was 24.14-34.17 (28.71±2.97) kg/m@*CONCLUSIONS@#IIH primarily affects women of childbearing age who are overweight. The major hazard of IIH is the severe and permanent visual loss. Typical image signs have high specificity in IIH diagnosis. Prompt diagnosis and effective treatment are significantly important to improve the outcomes of patients.

Fundus Photography with a Smartphone

PURPOSE: To evaluate the clinical usefulness, convenience, and possibility of using the medical records of fundus photography with a smartphone. METHODS: We used an ophthalmoscope to examine the images using a smartphone (iphone 6, Apple Inc., Cupertino, CA, USA) and +20D and +28D condensing lenses. Twenty-four subjects were selected for comparison with the conventional funduscopic camera. The posterior pole of the 45° range of the right eye and the fundus photograph taken using the smartphone were analyzed. We measured the distances between specific points on three photographs taken of the patient and calculated the photographing range. RESULTS: The +20 D lens was 0.80 ± 0.06 times smaller than that of the fundus camera and +1.12 ± 0.06 times bigger than that of the fundus photograph. When the area of the funduscope was converted to 45°, +20 D could visualize an area of 36.10 ± 2.82°, and +28 D could visualize a 50.56 ± 2.68° area. CONCLUSIONS: Without expensive equipment, a smart phone and a condensing lens can be used to easily perform fundus examination without the need for a special technique. Therefore, this technique is not only useful clinically, but also is very convenient for keeping medical records as fundus photographs.

Main Reasons for and Associated Factors of the First Fundus Examination in Diabetic Patients

PURPOSE: To determine the major reasons that diabetics decide to undergo their first fundus examination, and the factors influencing such reasons. METHODS: Of the patients with type II diabetes who presented to the Department of Ophthalmology in Gachon University Gil Medical Center, 164 patients who underwent their first fundus examination after being diagnosed with diabetes were included in the study. Face-to-face and phone interviews with these patients were conducted. RESULTS: The average prevalence period from the diagnosis of diabetes to the first fundus examination was 8.3 ± 7.5 years. Of the diabetics who underwent their first fundus examination, 52.4% had diabetic retinopathy, with no significant difference in prevalence between the male and female patients (p = 0.118). The most common reason for deciding to undergo the first fundus examination was recommendation by a doctor (53.7%). For those patients who received their first fundus examination after recommendation by a doctor, the prevalence period from diabetes was the shortest among all patients (p < 0.001), and the prevalence and severity of diabetic retinopathy were the lowest (p < 0.001 and p = 0.017, respectively). The number of fundus examinations conducted following recommendation by a doctor was significantly higher in secondary and tertiary hospitals than in primary hospitals (p < 0.001). Education on diabetes and knowledge of diabetic ocular complications were found to be significantly correlated (p < 0.001). CONCLUSIONS: For patients who are diagnosed with diabetes and treated in primary hospitals, who are older, or who did not receive education on diabetes, recommendation by a doctor for early fundus examination is particularly important regardless of subjective visual disturbance. Moreover, patient education should be offered and ophthalmic examination should be recommended in primary hospitals.

Converting a conventional wired‑halogen illuminated indirect ophthalmoscope to a wireless‑light emitting diode illuminated indirect ophthalmoscope in less than 1000/‑ rupees.

Aim: To report the “do it yourself” method of converting an existing wired‑halogen indirect ophthalmoscope (IO) to a wireless‑light emitting diode (LED) IO and report the preferences of the patients and the ophthalmologists. Subjects and Methods: In this prospective observational study, a conventional IO was converted to wireless‑LED IO using easily available, affordable electrical components. Conventional and the converted IO were then used to perform photo‑stress test and take the feedback of subjects and the ophthalmologists regarding its handling and illumination characteristics. Results: The cost of conversion to wireless‑LED was 815/‑ rupees. Twenty‑nine subjects, mean age 34.3 ± 10 years with normal eyes were recruited in the study. Between the two illumination systems, there was no statistical difference in the magnitude of the visual acuity loss and the time to recovery of acuity and the bleached vision on photo‑stress test, although the visual recovery was clinically faster with LED illumination. The heat sensation was more with halogen illumination than the LED (P = 0.009). The ophthalmologists rated wireless‑LED IO higher than wired‑halogen IO on the handling, examination comfort, patient’s visual comfort and quality of the image. Twenty‑two (81%) ophthalmologists wanted to change over to wireless‑LED IO. Conclusions: Converting to wireless‑LED IO is easy, cost‑effective and preferred over a wired‑halogen indirect ophthalmoscope.

Utility of optomap panoramic 200Tx in postoperative fundus examination among cataract patients / 国际眼科杂志(Guoji Yanke Zazhi)

To investigate the utility of optomap panoramic 200Tx in screening fundus disease among the patients after cataract surgery. ●METHODS: From November 18 th to December 31st , 2013 all 146 post- cataract surgery patients were recruited. All non - mydriatic fundus images were taken with the optomap panoramic 200Tx and were diagnosed by one masked retinal specialist. Non - mydriatic direct ophthalmoscope exam and mydriatic slit-lamp lens exam were also done by other two masked specialists. Comparisons of the three methods were made. ●RESULTS: Among 146 patients ( 161 eyes), 40 eyes (24. 8%) of retinal lesions was detected by non-mydriatic direct ophthalmoscope exam, 59 ( 36. 7%) by non -mydriatic optomap 200Tx exam, and 61 (37. 9%) by slit-lamp lens exam. Nine eyes ( 5. 6%) needed medical intervention immediately. Results of optomap 200Tx exams and slit - lamp lens exams were similar without statistically significant difference ( P > 0. 05), better than direct ophthalmoscope exam ( P ● CONCLUSlON: Opacification of the refractive medium makes thorough fundus examination impossible. So post-operative fundus examination is highly necessary and should be a routine. Optomap panoramic 200Tx, which shows no statistically difference from mydriatc slit- lamp lens exam, is a convenient and feasible method in discovering fundus pathological changes.

Nursing cooperation in the application of RetCamⅢ wide-field digital pediatric retinal imaging system / 中国实用护理杂志

Objective To investigate the nursing cooperation in clinical application of RetCamⅢ wide-field digital pediatric retinal imaging system.Methods 119 patients were given pointed nursing guidance while they underwent RetCamⅢ wide-field digital pediatric retinal imaging system examination.Results All patients accomplished the examination.29 cases had adverse reactions after using mydriatic.27 cases felt discomfort during the examination.22 cases appeared adverse reactions after examination,but relieved after nursing cooperation and guidance.Conclusions RetCamⅢ wide-field digital pediatric retinal imaging system is a rapid,safe and effective method for pediatric fundus examination.Favorable nursing cooperation and guidance is the guarantee of accurate and effective examination and harmonious relationship between doctor-nurse-patient.

Endoftalmitis endógenas: revisión de una serie de casos y revaloración de una entidad ocular grave / Endogenous endophthalmitis: case report and brief review of a serious ocular disease

Endogenous endophthalmitis (EE) is a prevalent but serious disease. Our aim was to describe cases of EE, with emphasis in the risk factors and the improvement of the prognosis. Methods: A review of EE cases was done between 1996-2011 in a secondary care hospital in Spain. The reported variables were: comorbidities, isolated microorganisms, susceptibility to antimicrobial treatment and visual prognosis. Results: 9 cases of EE were analyzed. All had some underlying disease, diabetes mellitus being the most frequent. Seven of the nine cases had a history of eye injury. Extraocular source of infection was identified in 7 cases, with predominantly gastrointestinal disease. Most microorganisms were isolated from blood cultures. The visual prognosis was unfavorable in five patients and was associated with virulent microorganisms and delayed treatment. Conclusions: EE is a rare disease that involve immunocompromised patients with ophthalmic disease. To improve prognosis, appropriate diagnosis and early treatment is require. Therefore, we recommend funduscopy examination in patients with sepsis, risk factors and prior history of ocular disease.

La endoftalmitis endógena (EE) es una patología poco prevalente aunque grave. Nuestro objetivo es describir los casos de EE diagnosticados en un hospital secundario español, con particular atención a los factores de riesgo y la posible mejora del pronóstico. Material y Métodos: Revisamos las historias clínicas de los pacientes diagnosticados de EE entre 1996-2011. Las variables recogidas fueron: co-morbilidades, microorganismo/s aislados y su susceptibilidad a los antimicrobianos, tratamiento administrado y pronóstico visual. Resultados: Se estudiaron nueve casos de EE. Todos presentaban alguna enfermedad de base, siendo diabetes mellitus la más frecuente. Siete de los nueve casos presentaron antecedentes de lesión ocular. La probable fuente extraocular se identificó en siete casos, predominando el foco gastrointestinal. La mayoría de microorganismos se aisló de hemocultivos. El pronóstico visual fue desfavorable en cinco pacientes, asociándose a microorganismos virulentos y al retraso terapéutico. Conclusiones: La EE es una enfermedad inusual que afecta a pacientes con inmunidad disminuida y antecedentes oftalmológicos. Para mejorar el pronóstico se requiere un diagnóstico acertado y un tratamiento precoz, todo un reto para médicos clínicos y microbiólogos. Por ello, recomendamos realizar un fondo de ojo a los pacientes con sepsis, factores de riesgo de EE y antecedentes de patología ocular.

Lipofuscin-and melanin-related fundus auto-fluorescence in patients with central serous chorioretinopathy / 中华实验眼科杂志

Background Auto-fluorescence(AF)imaging is a new non-invasive fundus examining technology.It is now playing an increasingly important role in the diagnosis of retinal diseases.Using a confocal Scanning Laser Ophthalmoscope microscope(cSLO),two types of AF can be obtained:melanin-related near-infrared fundus auto-fluorescence(NIA)and lipofuscin-related fundus auto-fluorescence(FAF).Objective The purpose of this study was to compare the outcome between NIA and FAF in patients with central serous chorioretinopathy (CSC).Methods FAF,NIA imaging and fundus fluorescein angiography(FFA)were performed on 28 eyes of 23 subjects using a cLSO.AF images were evaluated and compared with angiographic findings.Written informed consent was obtained before the initiation of this study.Results In 17 eyes of 15 cases with acute CSC,the leakage points on the FFA image showed three kinds of AF patterns:(1)hyper-AF,including FAF hyper-AF in 2 eyes(11.76％)and NIA hyper-AF in 4 eyes(23.53％).(2)Non-AF,including FAF non-AF in 10 eyes(58.82％)and NIA non-AF in 13 eyes(76.47％).(3)Normal AF,including normal AF of FAF in 5 eyes(29.42％).The AF in the retinal serous detachment area showed two kinds of characteristics:(1)hypo-AF,including 12 eyes(70.59％)with FAF hypo-AF and 10 eyes(58.82％)with NIA hypo-AF.(2)hyper-AF,including 5 eyes(29.41％)with FAF hyper-AF and 7 eyes (41.18％)with NIA hyper-AF.In 11 eyes of 8 cases with chronic CSC,the leakage on the FFA also showed an absence of AF.However,AF-absent areas also partly appeared in the non-leakage area of FFA.In NIA,the non-AF areas were often more visible than that in FAF.Serous detachment areas in chronic CSC usually displayed multiple AF forms,including granular-like non-AF,hyper-AF and hypo-AF,and the abnormal AF areas were often greater than that of the corresponding abnormal fluorescent area in FFA.Conclusions AF can be used to detect the functional status and metabolic activity of RPE in CSC eyes.

Application of eye ward class in young doctors' comprehensive ability training / 中华医学教育探索杂志

To develop the basic skills of young ophthalmic doctors,The following means can be used:the fundus examination training,doctor-patient communication ability training,teaching ward round,ward small lectures,giving patients lectures,encouraging young doctors to participate in scientific research conference and providing convenient learning places etc.for them to actively implementing knowledge and promote their ability.Ward as the earliest classroom for ophthalmic young doctor has its unique advantages,which is advantageous to the quick and good growth of young ophthalmologists.

Fundus Examination Rate in Diabetics and the Public Health Factors Associated With Fundus Examination Rate

PURPOSE: To investigate the fundus examination rate in diabetic patients and the public health factors associated with the fundus examination rate. METHODS: We analyzed the results of the third Korean National Health and Nutrition Examination Survey. We investigated the fundus examination rate in patients who had diabetes mellitus for more than 3 months during the previous year and determined the relationship of public health factors with the fundus examination rate. RESULTS: In all 547 patients (38.1%) received the fundus examination out of 1,437 total patients with diabetes mellitus. We found that many public health factors influenced the higher fundus examination rate, including patients who were residents in urban areas, women, office workers, university graduates, patients with a higher family income or more than 5 years duration of diabetes mellitus, patients with current insulin treatment, treatment of diabetes mellitus, education about diabetes mellitus, subjective visual problems or subjective health problems. However, age, marital status, health insurance and residential district did not influence the fundus examination rate. CONCLUSIONS: The Korean National Health and Nutrition Examination Survey is the largest health survey in Korea. This study is meaningful as a population-based study, not a clinic-based cross-sectional study and it suggests the basic data for improving the fundus examination rate in diabetes mellitus patients.

Peripheral Retinal Lesions Observed after Preoperative Evaluation for LASIK

PURPOSE: We estimated the incidence of retinal lesions at preoperative evaluation of retina for LASIK and investigate its clinical importance. METHODS: We estimated retrospectively the incidence of retinal lesions of the patients who visited our hospital with the purpose of correction of refractive error. The examination of retina upto periphery was done preoperatively. RESULTS: The mean spherical value and axial length were -6.5 +/- 3.4 diopters (range -26.0 ~ +17.0) and 25.4 +/- 2.0mm (range 15.7 ~ 34.5), respectively. The retinal lesions were found in 189 eyes of 139 persons (12.4%). Among them degenerative changes were found in 48 eyes of 34 persons, chorioretinal scars in 7 eyes of 7 persons, pigmented lesions in 28 eyes of 24 persons, and miscellaneous lesions in 106 eyes of 74 persons. There was a significant increase of spherical value and axial length in the group with retinal lesions -7.9 +/- 4.5 diopters (range -26.00 ~ -2.25), 26.5 +/- 2.3mm (range 23.1 ~ 34.5) compared to that without retinal lesions -6.1 +/- 3.4 diopters (range -25.00 ~ 17.00), 25.4 +/- 2.1mm (range 15.7 ~ 35.4). And the incidence of degenerative change and retinal tear was significantly increased in moderate myopes more than -4 diopters. CONCLUSIONS: LASIK is relatively a kind of safe refractive surgery, but to prevent the unexpected postoperative retinal complications, it is essential to thoroughly examine the retina upto periphery before surgery.

The Initial Fundus Examination and Severity of Diabetic Retinopathy in Diabetic Patients Diagnosed Over 30 Years of Age

The diagnosis of diabetics itself was frequently delayed in diabetic patients diagnosed over 30 years old. Therefore, fundus examination should be carried out at the time of diagnosis. The purpose of this study was to determine the delayed time of the initial fundus examination by ophthalmologists after diagnosis of diabetes and the reason for not having fundus examination in diabetic patients diagnosed when they were over 30 years of age. From January, 1998 to July, 1998, two hundred fifty-seven such diabetic patients were examined fundus for the first time in Department of Ophthalmology of the Kyungpook National University Hospital. Among these patients,the average delayed time of the initial fundus examination by ophthalmologists after the diagnosis of diabetes was 6.2 years and the morbidity rate was 39.7% (102 patients). At these patients,mild,moderate and severe nonproliferative diabetic retinopathy were 22.6% (58 patients), 10.1% (26 patients),2.7% (7 patients)respectively and proliferative diabetic retinopathy was 4.3% (11 patients). In conclustion, the delayed fundus examination was due to not knowing about timely necessity of the fundus examination. Diabetic patients as well as doctors who treat them should beeducated for the fundus examination at the time of diagnosis.