Résumé
RESUMEN Introducción: La primera evaluación ocular se realiza en el periodo neonatal con el reflejo rojo (RR). Objetivo: Determinar la sensibilidad y especificidad del reflejo rojo obtenido por medio de imágenes tomadas por pediatras con un teléfono inteligente, en niños menores de 24 meses. Materiales y Métodos: Estudio observacional de pruebas diagnósticas que incluyo lactantes menores de 24 meses. Tuvo dos etapas, La primera fue la búsqueda del reflejo rojo en imágenes obtenidas con un teléfono inteligente con pantalla 1280 x720 y densidad de pixeles de 267ppp, con cámara posterior de 13 MP y Flash LED, realizado por una operadora pediatra, en el consultorio en penumbras, con el niño a 6 metros de distancia en brazos de la madre. La presencia del reflejo rojo en ambos ojos se consideró normal y la ausencia uní o bilateral anormal. La segunda etapa fue el examen oftalmológico, en forma ciega en relación con la primera evaluación pediátrica. El análisis de los datos se realizó en el SPSS, utilizando estadísticas descriptivas. El comité de ética institucional aprobó el protocolo con consentimiento informado. Resultados: Fueron incluidos 228 lactantes con mediana edad de 7 meses (rangos intercuartílicos de 5 a 11 meses) El reflejo rojo con el teléfono celular fue normal en 206/228 y anormal en 21/228 Al examen por oftalmología pediátrica fue normal en 219/228 y anormal en 9/228. La sensibilidad del test con el teléfono inteligente fue de 88% y la especificidad del 94%. Se detectaron patologías visuales en el 4%. Conclusiones: La detección del reflejo rojo por pediatras con un teléfono inteligente tuvo una sensibilidad del 88% y una especificidad del 94%, En el 4% se detectaron patologías oculares.
ABSTRACT Introduction: The first ocular evaluation is performed in the neonatal period observing the red reflex (RR). Objective: To determine the sensitivity and specificity of the red reflex obtained with images taken by pediatricians using a smartphone, in children under 24 months. Materials and Methods: This was an observational study of diagnostic testing. We included infants aged 24 months and under. The study had two stages, The first stage involved searching for the red reflex using images obtained with a smartphone with a 1280 x720 screen and a pixel density of 267 ppp, with a 13 MP rear camera and LED Flash, which was carried out by a pediatrician operator, in a darkened office, with the child held by the mother 6 meters away from the camera. Presence of the red reflex in both eyes was considered normal and a unilateral or bilateral absence was abnormal. The second stage was an ophthalmological examination, which was blinded in relation to the first pediatric evaluation. Data analysis was performed with SPSS, using descriptive statistics. The institutional ethics committee approved the protocol, and informed consent was obtained. Results: 228 infants with a median age of 7 months were included (interquartile ranges from 5 to 11 months). The red reflex with the cell phone was normal in 206/228 and abnormal in 21/228. On examination by pediatric ophthalmology, the exam was normal in 219 / 228 and abnormal in 9/228. The sensitivity of the test with the smartphone was 88% and the specificity 94%. Visual pathologies were detected in 4%. Conclusions: The detection of the red reflex by pediatricians with a smartphone had a sensitivity of 88% and a specificity of 94%. Ocular pathologies were detected in 4% of subjects.
Résumé
Objective: To identify the causes of low visual acuity and systemic morbidities that limit ambulation and access to eye care in geriatric clinics in Rio de Janeiro. Methods: This cross-sectional study evaluated 187 patients from three geriatric clinics in Rio de Janeiro between January 2010 and January 2011. The inclusion criteria were individuals with a visual acuity of less than of equal to 20/200 in either eye (118 individuals), without optical correction. The exclusion criteria were individuals who refused to participate and those unable to undergo screening because of mental disabilities (6 individuals). Of the 187 individuals evaluated, 63 had visual acuity above 20/200. Results: A total of 118 individuals with a visual acuity of ≤20/200 effectively participated in the study after meeting the inclusion and exclusion criteria. In addition, 57 participants (48.3%) presented systemic disabling morbidities. Of the 118 individuals with low visual acuity, 27.96% had cataract and 26.27% had refractive errors. Conclusion: Most of the patients from geriatric clinics experienced ocular morbidities, but their proper treatment resulted in improved visual acuity. A more socially oriented problem associated with eye care involved the difficulty of access to ophthalmologic consultations. .
Objetivo: Identificar causas de baixa acuidade visual e morbidades sistêmicas que dificultem a deambulação e o acesso à tratamento oftalmológico em clínicas geriátricas do Rio de Janeiro. Métodos: Estudo transversal com 187 indivíduos de 3 clínicas geriátricas do Rio de Janeiro, no período de janeiro de 2010 à janeiro de 2011. O critério de inclusão foi todos os indivíduos com acuidade visual menor ou igual a 20/200 em qualquer olho (118 indivíduos) e sem atualização da correção óptica. O critério de exclusão foi indivíduos que se recusaram à participar do estudo e indivíduos incapazes de realizarem os exames por déficit mental (6 indivíduos). Dos 187 indivíduos avaliados, 63 indivíduos tinham acuidade visual melhor que 20/200. Resultados: Participaram do estudo efetivamente, após os critérios de inclusão e exclusão, 118 indivíduos com variadas causas de acuidade visual menor ou igual 20/200. Foram encontrados no estudo 57 (48,3%) indivíduos com a presença de morbidades sistêmicas incapacitantes. Dos 118 indivíduos com baixa acuidade visual, que participaram do estudo, 27,96% apresentaram catarata e 26,27% ametropias. Conclusão: A maioria dos indivíduos destas clínicas geriátricas apresentou morbidades oculares que com tratamento adequado permitem a melhora da acuidade visual. Foi encontrado um problema mais de cunho social pela dificuldade de acesso à consulta oftalmológica. .