ABSTRACT
BACKGROUND AND OBJECTIVE: To determine the accuracy and sensitivity of a single-field non-mydriatic digital fundus image interpreted by an ophthalmologist and performed within a primary care setting. PATIENTS AND METHODS: Fundus photography using a digital non-mydriatic camera was performed on both eyes of 1,175 consecutive patients as part of an executive health program. All fundus images included a 45° field of the posterior pole capturing the optic nerve and macular area. Diagnostic findings were recorded and appropriate recommendations for follow-up were made. Patients were then contacted to see whether appropriate follow-up was successfully completed and chart reviews were performed to determine biomicroscopic findings. RESULTS: Photographs were adequate in both eyes in 1,117 patients (95.1%). Examination findings were normal in both eyes in 951 (85.1%) patients. Abnormal findings were noted in either eye in 166 (14.9%) patients. The most common abnormal findings were macular degeneration (57/166, 34.3%), optic nerve cupping (45/166, 27.1%), hypertensive retinopathy (15/166, 9.0%), and choroidal nevi (10/166, 6.0%). In all patients with abnormal findings, routine follow-up ophthalmologic examination with an eye care specialist was indicated and none of the patients required urgent attention. Sensitivity was found to be 87% and stratification was performed based on the initial diagnosis. False-positive results were from confounding diagnoses rather than true false-positives. CONCLUSION: Single-field non-mydriatic fundus photography is accurate and sensitive for screening retinal disease in a primary care setting.
Subject(s)
Ambulatory Care Facilities , Diagnosis, Computer-Assisted , Fundus Oculi , Photography , Retinal Diseases/pathology , Diagnostic Techniques, Ophthalmological , Feasibility Studies , Female , Humans , Male , Mass Screening/methods , Middle Aged , Mydriatics , Primary Health Care/methods , Sensitivity and SpecificityABSTRACT
Macrophage activation syndrome (MAS) is a disorder characterized by increased activation of mononuclear cells leading to phagocytosis of blood cell precursors in the bone marrow. We describe a case of MAS triggered by disseminated histoplasmosis occurring in a patient with Still's disease on long-term treatment with adalimumab.
Subject(s)
Antibodies, Monoclonal/adverse effects , Antirheumatic Agents/adverse effects , Histoplasmosis/complications , Macrophage Activation Syndrome/etiology , Still's Disease, Adult-Onset/complications , Still's Disease, Adult-Onset/therapy , Adalimumab , Antibodies, Monoclonal, Humanized , Humans , Phagocytosis , Young AdultABSTRACT
The measurement of blood pressure in the physician's office is subject to a number of observer errors and also to the "white-coat effect." Automatic devices that measure blood pressure without a human observer in the room can eliminate many of these problems. We argue for greater use of these devices in the physician's office.
