Ensuring high-quality telemedicine consultations in community eye care

Telemedicine has been a growing feature in ophthalmology in the UK, particularly since the inception of the Diabetic Retinal Screening Service (DRSS). The COVID-19 pandemic has accelerated this trend more than anyone would have envisaged and it is likely to remain a key part of care of patients with ophthalmic pathology. It is vital that however many consultations are undertaken, these meet the high-quality standards that patients and regulators expect. For a range of both common and emergency eye conditions that are frequently managed in the community, we explore the examinations and investigations required to provide a comprehensive assessment and accurate diagnosis in the community eye care setting. We also propose parameters and quality standards for each investigation to ensure that the clinician interpreting these has the required information to make an appropriate diagnosis. We suggest that providers of teleophthalmology consultations use these quality standards to minimise their risk of inappropriate diagnosis and treatment based on insufficient or inaccurate information and so to mitigate against the potential legal implications that can result from suboptimal clinical decisions. [ FROM AUTHOR] Copyright of Optometry in Practice is the property of College of Optometrists and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Red Blood Cell-Derived Iron Alters Macrophage Function in COPD.

Lung macrophage iron levels are increased in COPD patients. Lung macrophage iron levels are thought to be increased by cigarette smoke, but the role of red blood cells (RBCs) as a source of iron has not been investigated. We investigate RBCs as a potential source of alveolar iron in COPD, and determine the effect of RBC-derived iron on macrophage function. We used lung tissue sections to assess RBC coverage of the alveolar space, iron and ferritin levels in 11 non-smokers (NS), 15 smokers (S) and 32 COPD patients. Lung macrophages were isolated from lung resections (n = 68) and treated with hemin or ferric ammonium citrate (50, 100 or 200 µM). Lung macrophage phenotype marker gene expression was measured by qPCR. The phagocytosis of Non-typeable Haemophilus influenzae (NTHi) was measured by flow cytometry. Cytokine production in response to NTHi in iron-treated macrophages was measured by ELISA. Lung macrophage iron levels were significantly correlated with RBC coverage of the alveolar space (r = 0.31, p = 0.02). Furthermore, RBC coverage and lung macrophage iron were significantly increased in COPD patients and correlated with airflow obstruction. Hemin treatment downregulated CD36, CD163, HLA-DR, CD38, TLR4, CD14 and MARCO gene expression. Hemin-treated macrophages also impaired production of pro-inflammatory cytokines in response to NTHi exposure, and decreased phagocytosis of NTHi (200 µM: 35% decrease; p = 0.03). RBCs are a plausible source of pulmonary iron overload in COPD. RBC-derived iron dysregulates macrophage phenotype and function.