Comprehensive standardized ophthalmic telemedicine.

The Electrodiagnostic Neurophysiological Automated Analysis (ENAA) telematic system was developed in the EU EUREKA project. To validate the system 2500 electrodiagnostic tests were administered in a standardized manner during a three-year period. The tests were performed on 70 normal subjects and 500 patients in five laboratories in three European countries. The data were transmitted to the Bristol Telematic Electrodiagnostic Centre in the Bristol Eye Hospital. Data from normal subjects were not significantly different between laboratories. Data from patients were reported upon and the conclusions transmitted to the place of origin. The system provided the remote consultant with multimedia data, including medical images such as colour fundus photography and angiography, video and sound.

Optimised averaging by on-line statistical verification of response in clinical electrodiagnostic trials.

Real time statistical verification of the averaged response in many established electrodiagnostic tests may result in a substantially reduced number of presented stimuli thus minimising the test's duration and reducing the overall time load on the patient examined. Furthermore, a sufficient number of stimuli may be automatically established in an objective statistical way by accounting for the response amplitude and variance, noise amplitude etc., resulting in averages with matching signal to noise ratio. A technique of real time statistical verification of the response based upon single trial data analysis was developed and verified in clinical electroretinographic (ERG) tests.

The Farnsworth-Munsell 100 hue test in the first episode of demyelinating optic neuritis.

The Farnsworth-Munsell 100 hue test (F-M 100) was used to examine 30 patients with their first episode of unilateral demyelinating optic neuritis (DON) at presentation, after 6 weeks and after 6 months. Twelve patients satisfactorily completed the test with the affected eye at presentation. This number had increased to 23 by 6 weeks and to 27 by 6 months. No patient with a visual acuity of LogMAR 0.86 (Snellen equivalent approx 6/43) or worse, could complete the test. The mean total error score of affected eyes showed significant improvement at each subsequent examination but was always worse than the non-affected eyes. There was a significant correlation between total error scores and visual acuities of affected eyes at presentation and after 6 months. Fourteen patients recovered a visual acuity of LogMAR 0.0 (Snellen equivalent 6/6) or better but the total error scores of the affected eyes were significantly worse than the non-affected eyes (p = 0.017), indicating that defective colour vision is an indicator of a previous episode of DON despite the recovery of normal visual acuity. DON is reported to produce a red-green (Type II) axis of colour defect but individual F-M 100 polar diagrams were usually generally abnormal and did not show any predominance of recognisable axis of colour defect at any examination. Group averaging of the F-M 100 data from such a well-defined group of patients with acute DON revealed a significant bipolar abnormality in the tritan (blue-yellow) axis at presentation which was not demonstrated at the subsequent examinations or at any examination of the non-affected eyes.

Clinical and infrared pupillometry in central retinal vein occlusion.

Measurements of pupillary reactivity and size were recorded using neutral density filters and infrared pupillometry (IRP) in a prospective masked study of acute central retinal vein occlusion (CRVO) to quantify the two methods of measurement and to compare their value in the prediction of rubeosis. Thirty two patients were examined within 45 days of disease onset. The mean relative afferent pupillary defect (RAPD) with filters was significantly greater in patients who developed rubeosis than in those who did not (0.9 vs 0.3 log units; p = 0.012). Using IRP, the pupillary diameters in the dark (maximum) and in the light (minimum) were significantly greater, the rate of pupillary constriction was significantly lower, and the latency of constriction was significantly greater in affected eyes than in unaffected eyes. The differences between affected and unaffected eyes in the IRP parameters of latency, rate, maximum, and minimum pupillary diameters were significantly greater in patients who developed rubeosis than in those who did not. Discriminant analysis of the IRP parameters correctly and statistically significantly identified rubeotic patients with 83% sensitivity and 95% specificity. An RAPD of > or = 0.6 log units was 83% sensitive and 70% specific in this regard. It is concluded that pupillary reactions are abnormal in many patients with acute CRVO, as measured by both pupillometric methods. The degree of these abnormalities has a relationship to the development of rubeosis, and might prove useful in planning the follow up of these patients or in deciding whether to apply panretinal photocoagulation. The neutral density filter test is readily available but subjective. IRP is more specific, objective, and suited to further development, but requires sophisticated equipment.