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@#Cardiovascular diseases is the leading cause of threat to human life and health worldwide. Early risk assessment, timely diagnosis, and prognosis evaluation are critical to the treatment of cardiovascular diseases. Currently, the evaluation of diagnosis and prognosis of cardiovascular diseases mainly relies on imaging examinations such as coronary CT and coronary angiography, which are expensive, time-consuming, partly invasive, and require high professional competence of the operator, making it difficult to promote in the community or in areas where medical resources are scarce. The fundus microcirculation is a part of the human microcirculation and has similar embryological origins and physiopathological features to cardiovascular circulation. Several studies have revealed fundus imaging biomarkers associated with cardiovascular diseases, and developed and validated intelligent diagnosis and treatment models for cardiovascular diseases based on fundus imaging data. Fundus imaging is expected to be an important adjunct to cardiovascular disease diagnosis and treatment given its noninvasive and convenient nature. The purpose of this review is to summarize the current research status, challenges, and future prospects of the application of artificial intelligence based on multimodal fundus imaging data in cardiovascular disease diagnosis and treatment.
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Objective:To compare the consistency and difference of non-mydriatic two-field 45° ultra-wide field Optos and Clarus500 fundus imaging in a large-scale diabetic retinopathy (DR) screening.Methods:A diagnostic methodology study. From November 2020 to August 2021, 526 eyes of 277 patients with type 2 diabetes who diagnosed in Department of Ophthalmology, Henan Provincial People's Hospital were included in the study. Among them, there were 175 males with 328 eyes and 102 females with 198 eyes; the age was 53±10 years old. The same experienced technician performed the non-mydriatic dual-field 45° fundus imaging and the non-mydriatic ultra-wide-angle imaging system Optos, Clarus500 single-field fundus imaging examination on the patient on the same day, and obtained the dual-field 45° fundus image and Optos, Clarus500 single-field fundus image. The Optos and Clarus500 single-field fundus images in the same area as the dual-field 45° fundus image were captured by Photoshop software, and the Optos and Clarus500 dual-field fundus images were obtained. Subsequently, two experienced ophthalmologists performed interpretation and DR grading of the 5 groups of images, respectively. Images with inconsistent grading results were interpreted by a third ophthalmologist and used as the final grading result. In order to avoid the mydriatic dual-field 45° imaging interpretation results as the standard, the consistency and detection rate difference of the two ultra-wide-angle imaging systems in the rapid DR screening results were evaluated. The weighted Kappa ( κ) test was used to analyze the consistency of DR diagnosis between dual-field 45° fundus imaging and Optos and Clarus500 fundus imaging; χ2 test was used to compare the detection rates of DR between different imaging systems. Results:Compared with the dual-field 45° fundus image, the Clarus500 single-field had a higher DR detection rate ( χ2=24.965, P<0.001), and the Optos dual-field fundus image had a lower DR detection rate ( χ2=49.559, P<0.001). Compared with the DR detection rate of dual-field 45° fundus image, Optos single-field fundus image, Clarus500 double-field fundus image had no significant difference ( χ2=2.572, 0.649; P=0.109, 0.421). Compared with Optos, Clarus500 single-field and dual-field fundus images DR detection rate, the difference was statistically significant ( χ2=43.214, 61.216; P<0.001). Consistency assessment of DR grading results: dual-field 45° fundus images and Clarus500 dual-field fundus images ( κ value=0.932, 95% confidence interval ( CI) 0.907-0.956) were highly consistent; dual-field 45° fundus images and Optos single-field fundus images [ κ value=0.474, 95% CI 0.417-0.532], Optos dual-field fundus image ( κ value=0.495, 95% CI 0.438-0.551), Optos dual-field fundus image ( κ value=0.495, 95% CI 0.438-0.551) and Clarus500 dual-field fundus image ( κ value=0.452, 95% CI 0.395-0.506) were moderately consistent; dual-field 45°fundus images and Clarus500 single-field fundus images ( κ value=0.354, 95% CI 0.303-0.403) and Optos single-field fundus images and Clarus500 single-field fundus images ( κ value=0.347, 95% CI 0.287-0.393) showed general agreement. Conclusions:Compared with Optos dual-field fundus image, dual-field 45°fundus image and Clarus500 dual-field fundus image have high consistency in the grading results of DR rapid screening. Compared with Optos single-field fundus image, the detection rate of the DR of Clarus500 single-field fundus image is higher.
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Objective:To explore the application of multispectral fundus imaging (MSI) in central serous chorioretinopathy (CSC).Methods:A diagnostic test study was conducted.Eighty-five eyes from 69 patients with macular diseases were enrolled in Renmin Hospital of Wuhan University from September 2017 to May 2018.There were 62 males (77 eyes) and 7 females (8 eyes) among the 69 patients with an average age of (48.0±11.2) years.The patients were divided into CSC group (45 cases, 61 eyes) and non-CSC group (24 cases, 24 eyes) according to whether suffering from CSC or not.Color fundus photography, fundus fluorescein angiography (FFA), indocyanine green angiography, spectral domain-optical coherence tomography and MSI were performed in the two groups and the images were collected.With FFA as the gold standard, the sensitivity, specificity, false positive rate, false negative rate, positive predictive value and negative predictive value of MSI in the diagnosis of CSC were calculated.Kappa consistency test was used to evaluate the consistency of MSI and FFA in diagnosing CSC, and to evaluate the diagnostic value of MSI in CSC.This study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Renmin Hospital of Wuhan University (No.WDRY2019-K037). Written informed consent was obtained from each subject prior to any medical examination.Results:The sensitivity, specicity, false positive rate, false negative rate, positive predictive value and negative predictive value of MSI for identifying CSC were 88.5%, 91.7%, 8.3%, 11.5%, 96.4% and 75.9%, respectively.The Kappa coefficient of agreement was 0.754.There was no significant difference in the identification of CSC between MSI and FFA ( χ2=1.780, P=0.180). Hyper-reflective signals corresponding to the leakage points were better detected with MSI images at 620-850 nm wavelength.The clear boundary of serous neuroepithelial detachment area was better detected with MSI images at 590-810 nm wavelength.The retinal pigment epithelium damage was better detected with MSI images at 660-850 nm wavelength. Conclusions:There is a good consistency between MSI and FFA.MSI can be an effective noninvasive inspection method for CSC.
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Purpose: The gold standard for evaluating Retinopathy of prematurity (ROP), a potentially blinding disease in preterm babies, is by indirect ophthalmoscopy which is quite subjective. Digital imaging with RetCam, an advanced wide field imaging system is more precise but it is not easily available or affordable. Smartphones are being explored as an alternate cost effective and accessible imaging tool. This is possible because of the good illumination and the built-in high resolution cameras available in modern smartphones. The aim of this study is to illustrate the utility of MII RetCam assisted smartphone based fundus imaging (MSFI) in the documentation and monitoring of ROP. Methods: Single-centre, retrospective observational study of all the preterm babies subjected to MSFI as part of ROP screening from September 2017 to November 2018. iPhone 4S and + 20 Diopter lens attached to the MII RetCam device was used for fundus imaging at baseline and during follow up. The statistical analysis used for the same is the SPSS statistical software. Results: Good quality images of central and peripheral retina could be captured in 33 out of 42 babies (78.57%) with ROP. Serial imaging done in 24 babies with ROP helped in precise monitoring of the disease and planning management. Incidentally detected non-ROP findings were also documented. Unique design of the device enabled imaging by a single examiner. Image database created was useful for academic and counselling purposes. Smaller field images which can cause difficulty in distinguishing the zones is a limitation. Conclusion: MSFI is a potential alternate imaging tool enabling objective documentation and monitoring of ROP in low resource settings.
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@#AIM: To investigate the relationship between the prevalence of peripheral retinal degeneration and myopic degree by using the fort ultra wide angle scanning laser ophthalmoscope(Daytona P200T)for small, early and high middle school period of low, medium and high myopia students peripheral retinal scan.<p>METHODS: With method of stratified random cluster sampling, to select myopia students in two primary schools, one junior middle school and one senior high school in Mianyang. According to different degrees, the myopia was divided into low, medium and high myopia, with 300 people and 600 eyes respectively. Application of Daytona P200T in natural pupil downward fundus image acquisition, and then the senior ophthalmologist performed the fundus examination under the slit lamp after pupil dilation.<p>RESULTS: The prevalence of peripheral retinal degeneration was different among different refractive groups, and the higher the myopia, the higher the prevalence of peripheral retinal degeneration(χ2=75.76, <i>P</i><0.001). Comparison between different degree groups prevalence of peripheral retinal degeneration: frost degeneration(STD)no statistical difference between the three groups(χ2=5.66,<i> P</i>=0.059), lattice degeneration(LD), snail track degeneration(SD), non-oppressive whitening(WWP), cystic degeneration(CD), hiatal(DRP), pigment degeneration(RP)were differences among three groups. For further comparison, except WWP(χ2=9.385, <i>P</i>=0.002), low height both two(<i>P</i>>0.017). Moderately and highly group compared, in addition to the CD(χ2=8.525, <i>P</i>=0.004)and the RP(χ2=6.454, <i>P</i>=0.011), the rest were not tested statistically. Compared with the prevalence of peripheral retinal degeneration in different segments, retinal degeneration was observed in 34 eyes(5.7%)in primary school, 90 eyes(14.9%)in junior middle and 130 eyes(21.9%)in senior high. The prevalence of peripheral retinal degeneration increased with the increase of medical grade(χ2=64.79, <i>P</i><0.001). The prevalence of WWP and CD showed no statistical difference between junior middle school and primary school and senior high school(<i>P</i>>0.05). For further comparison, except LD(χ2=6.209, <i>P</i>=0.013)and STD(χ2=9.953, <i>P</i>=0.002), no statistical difference in the primary schools and junior middle, junior middle and senior high(<i>P</i>>0.017), statistical difference was detected between the primary schools and senior high school(<i>P</i><0.017).<p>CONCLUSION: The prevalence of peripheral retinal degeneration of myopia was positively correlated with myopia and learning period.
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Based on the Gullstrand I model eye, a simplified model eye for testing fundus imaging device is designed. The model eye can reach the following requirements:(1) The refractive characteristics of the ocular refractive tissue are simulated, and the equivalent focal length in air is 17 mm; (2) The differences between relative refractive index differences of the adjacent materials of the simplified model eye and relative refractive index differences of any adjacent two layers (cornea and aqueous humor, aqueous humor and lens, lens and vitreous body) of the Gullstrand I model eye are not more than 1%; (3) In the case of the incident aperture diameter of 3 mm, the differences of radii of the diffuse spots formed by the paraxial light and the axial light are not more than 15%; (4) The differences of angles of chief ray and tangent line of the fundus are not more than 1°; (5) In the case of the incident aperture diameter of 3 mm, the differences of MTF values of the near axis light are not more than 0.1. The simplified model eye can be expected to be used for testing fundus imaging device instead of the test method in ISO 10940:2009 Ophthalmic instruments-Fundus cameras.
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Córnea , Fondo de Ojo , Cristalino , Diagnóstico por Imagen , Refracción OcularRESUMEN
The methods of fundus examination include direct and indirect ophthalmoscopy and imaging with a fundus camera are an essential part of ophthalmic practice. The usage of unconventional equipment such as a hand‑held video camera, smartphone, and a nasal endoscope allows one to image the fundus with advantages and some disadvantages. The advantages of these instruments are the cost‑effectiveness, ultra portability and ability to obtain images in a remote setting and share the same electronically. These instruments, however, are unlikely to replace the fundus camera but then would always be an additional arsenal in an ophthalmologist’s armamentarium.
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Fundus imaging with a fundus camera is an essential part of ophthalmic practice. A mobile phone with its in‑built camera and flash can be used to obtain fundus images of reasonable quality. The mobile phone can be used as an indirect ophthalmoscope when coupled with a condensing lens. It can be used as a direct ophthalmoscope after minimal modification, wherein the fundus can be viewed without an intervening lens in young patients with dilated pupils. Employing the ubiquitous mobile phone to obtain fundus images has the potential for mass screening, enables ophthalmologists without a fundus camera to document and share findings, is a tool for telemedicine and is rather inexpensive.
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Fundus photography in adults and cooperative children is possible with a fundus camera or by using a slit lamp-mounted digital camera. Retcam™or a video indirect ophthalmoscope is necessary for fundus imaging in infants and young children under anesthesia. Herein, a technique of converting and using a digital video camera into a video indirect ophthalmoscope for fundus imaging is described. This device will allow anyone with a hand-held video camera to obtain fundus images. Limitations of this technique involve a learning curve and inability to perform scleral depression.
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Preescolar , Diseño de Equipo , Fondo de Ojo , Humanos , Lactante , Curva de Aprendizaje , Oftalmoscopía/métodos , Grabación de Cinta de Video/instrumentaciónRESUMEN
AIM: To report a case of Susac-syndrome (SS) in a 25 years old female with sudden peripheral visual field defects and hearing loss.METHODS: A 25 years old female with sudden peri-pheral visual field defects and hearing loss was reported, and the correlations between retinal findings in ultra-widefield-angiography and presented visual field defects were documented.RESULTS: Our patient presented the characteristic clinical triad of SS. Certain correlations between retinal findings in ultra-widefield-angiography and visual field defects could be shown.CONCLUSION: Ultra-widefield-angiography has been proven to be a valuable tool to detect and follow peripheral lesions of SS in clinical management.