Updates on ophthalmic imaging features of optic disc drusen, papilledema, and optic disc edema.

PURPOSE OF REVIEW: Optic nerve head elevation can be associated with vision loss. This review provides an update regarding key features of optic disc drusen (ODD) compared with papilledema from increased intracranial pressure and optic disc edema from other causes. RECENT FINDINGS: Clinical history and funduscopic examination are not sufficient to correctly diagnose different causes of optic nerve head elevation. Multimodal ophthalmic imaging is noninvasive and should be used as first-line diagnostic testing to distinguish optic disc edema or papilledema from pseudoedema. Advanced ophthalmic imaging, including enhanced depth imaging optical coherence tomography (EDI-OCT) and autofluorescence imaging, can visualize ODD at high resolution and determine whether there is optic disc edema. OCT angiography does not require contrast and can rapidly visualize papillary, peripapillary, and macular microvasculature and identify important vascular biomarker of ischemia and, potentially, visual prognosis. SUMMARY: Multimodal ophthalmic imaging can help in the diagnosis of ODD and optic disc edema and identify patients at high risk of vision loss and neurological issues in order to ensure appropriate diagnosis and treatment.

[Ophthalmoscopy in the era of optical coherence tomography]. / Ophthalmoskopie im Zeitalter der optischen Kohärenztomographie.

For more than one and a half centuries ophthalmoscopy has been the main diagnostic procedure in ophthalmology for diagnosing retinal diseases. The techniques have improved over the years and ophthalmoscopy is still the gold standard for all retinal diseases, especially for peripheral retinal diseases. The introduction of optical coherence tomography (OCT) has revolutionized ocular diagnostics of macular diseases as OCT is able to detect retinal changes that cannot be diagnosed as well with ophthalmoscopy alone. Nevertheless, diagnosis of a retinal disease should not be made on the basis of OCT findings alone but always in combination with ophthalmoscopy. If necessary further diagnostic procedures should be added to improve the accuracy of diagnosis, to follow the course of the disease and to control the success of treatment.

Evolución, recientes avances y futuro desarrollo de la tomografía de coherencia óptica / Evolution, recent progress and future development of optical coherence tomography

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Fiabilidad en el cribado de la retinopatía del prematuro mediante el análisis de retinografías / Reliability of retinal imaging screening in retinopathy of prematurity

INTRODUCCIÓN: La retinopatía del prematuro (ROP) es una de las principales causas de ceguera infantil potencialmente evitable. Los avances en los cuidados neonatales consiguen la supervivencia de niños de bajo peso extremo asociado con una mayor incidencia de la enfermedad. El objetivo de este estudio es evaluar la fiabilidad en el diagnóstico de la ROP a través de retinografías obtenidas con la cámara de campo amplio RetCam3 y estudiar la variabilidad en el diagnóstico de ROP en función del evaluador. MATERIAL Y MÉTODOS: El examen con oftalmoscopio indirecto fue realizado por un oftalmólogo pediátrico experto en ROP. Las imágenes retinianas fueron obtenidas por el mismo oftalmólogo y un técnico especializado en la captura de imágenes digitales. Un total de 30sets de imágenes fueron analizados por 3 grupos enmascarados: grupo A (8 oftalmólogos), grupo B (5 expertos en visión) y grupo C (2 oftalmólogos expertos en ROP). RESULTADOS: Acorde con el diagnóstico mediante oftalmoscopia indirecta, la sensibilidad (26-93), el índice Kappa (0,24-0,80) y el porcentaje de aciertos fueron estadísticamente significativos en el grupo C para el diagnóstico de ROP tipo1. En el diagnóstico de ROP tipo1+tipo2 el índice Kappa (0,17-0,33) y el porcentaje de aciertos (58-90) fueron estadísticamente significativos, obteniendo valores superiores en el grupo C. CONCLUSIONES: El diagnóstico realizado por oftalmólogos expertos en ROP con el retinógrafo móvil RetCam3 ha demostrado ser un método fiable

INTRODUCTION: The retinopathy of prematurity (ROP) is a potentially avoidable cause of blindness in children. The advances in neonatal care make the survival of extremely premature infants, who show a greater incidence of the disease, possible. The aim of the study is to evaluate the reliability of ROP screening using retinography imaging with the RetCam3 wide-angle camera and also study the variability of ROP diagnosis depending on the evaluator. MATERIAL AND METHODS: The indirect ophthalmoscopy exam was performed by a Pediatric ROP-Expert Ophthalmologist. The same ophthalmologist and a technician specialized in digital image capture took retinal images using the RetCam3 wide-angle camera. A total of 30image sets were analyzed by 3 masked groups: group A (8 ophthalmologists), group B (5 experts in vision), and group C (2 ROP-expert ophthalmologists). RESULTS: According to the diagnosis using indirect ophthalmoscopy, the sensitivity (26-93), Kappa (0.24-0.80), and the percent agreement were statistically significant in group C for the diagnosis of ROP Type1. In the diagnosis of ROP Type1+Type2, Kappa (0.17-0.33) and the percent agreement (58-90) were statistically significant, with higher values in group C. CONCLUSION: The diagnosis, carried out by ROP-expert ophthalmologists, using the wide-angle camera RetCam3 has proved to be a reliable method

[The value of autofluorescence imaging in diagnosis of retinal diseases].

Results of fundus autofluorescence imaging using confocal scanning laser ophthalmoscope HRA II ("Heidelberg Engeneering", Heidelberg, Germany) are presented. 106 patients with various retinal and optic nerve conditions were examined. The following conditions were diagnosed using autofluorescence imaging: early stage of age-related macular degeneration, macular hard and soft drusen, signs of retinitis pigmentosa, senile macular hole, central serous chorioretinopathy and optic disc drusen.

Escleritis posterior bilateral / Bilateral posterior scleritis

La escleritis posterior es un proceso inflamatoriode la parte posterior de la esclera. Su prevalencia esmuy baja y el diagnóstico puede resultar complicadopor la ausencia de signos oculares externos. Es más frecuenteen mujeres. Cuando aparece en pacientes jóvenesno suele tener otras patologías asociadas, pero enmayores de 55 años hasta un tercio de los casos tienenrelación con alguna enfermedad sistémica, sobre todola artritis reumatoide. El diagnóstico de esta patologíapuede requerir un abordaje multidisciplinar y la colaboraciónde oftalmólogos con neurólogos, internistas oreumatólogos. En este artículo se describe un caso deescleritis posterior bilateral idiopática (AU)

Posterior scleritis is an inflammatory process ofthe posterior part of the sclera. Its prevalence is verylow and its diagnosis can be complicated due to theabsence of external ocular signs. It is more frequentin women. In young patients it does not usually haveother associated pathologies, but in those over 55 yearsnearly one-third of the cases have a relation with somesystemic disease, above all rheumatoid arthritis. Thediagnosis of this pathology can require a multidisciplinaryapproach and the collaboration of ophthalmologistswith neurologists, internists or rheumatologists.This article describes a case of idiopathic bilateral posteriorscleritis (AU)

Retinografía no midriática para la detección de la retinopatía diabética. Un ejemplo de adaptación al medio / Non-mydiatric retinography for the detection of diabetic retinopathy. An example of adaptation to the setting

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Scanning laser polarimetry - a review.

Glaucoma is a leading cause of irreversible blindness worldwide. Retinal ganglion cells and their axons represent the selective target of the disease. When visual function is still intact on standard automated perimetry and optic disc appearance is suspicious, an early diagnosis may be supported by the identification of a retinal nerve fibre layer (RNFL) defect in the peripapillary area. At present days, computer-based, real-time imaging of the peripapillary RNFL is available through instruments of easy use and with high levels of accuracy and reproducibility. Scanning laser polarimetry is performed by a confocal scanning laser ophthalmoscope with an integrated polarimeter (GDx-VCC). There is a considerable amount of scientific evidence about the role of this imaging technique for glaucoma diagnosis. The aim of this review is to describe the principles of operation, the examination procedure, the clinical role, the results of main diagnostic studies and the future development of the software for the scanning laser polarimetry.

Análisis del espesor de la capa de fibras nerviosas en niños de 6 a 9 años / Retinal nerve fiber layer thickness analysis in children from 6 to 9 years of age

Objetivo: Establecer una base de datos para el GDx-VCC representativa para nuestra población de entre 6 a 9 años y analizar los datos obtenidos por rango de edades. Método: Se analizó la densidad de la CFN mediante oftalmoscopía de barrido con láser (GDx) a 116 niños procedentes de un único colegio y los resultados fueron sometidos a estudio estadístico por edades y en global a fin de determinar el rango de valores considerable como la normalidad para esa población y las posibles diferencias entre ellos. Resultados: En el análisis global por cuadrantes de los datos estudiados por el GDx se encontró un promedio TSNIT de 59,43 (IC95% 58,41-60,45); superior de 71,35 (IC95% 69,99-72,70); inferior de 70,08 (IC95% 68,71-71,45) y una desviación estándar TSNIT de 25,11 (IC95% 24,36-25,86). En el análisis por edades se observan valores medios por cuadrantes comparables a los del global. Conclusiones: El estudio de la CFN mediante GDx se puede realizar sin problema en la población infantil de 6 a 9 años dada la mínima colaboración requerida, obteniendo así datos objetivos sobre su estado y desarrollo durante estas edades

Purpose: To establish a database of scanning laser polarimetry (GDx) parameters for children between 6 and 9 years of age and compare the results at each age. Methods: The retinal nerve layer thickness of 116 children from one school was evaluated with GDx and the results were analyzed for each age and for the entire group to determinate the normal range for that population. Results: In the global analysis of the software-derived GDx parameters, we obtained a TSNIT average of 59.43 (IC95% 58.41-60.45), a superior average of 71.35 (IC95% 69.99-72.70), an inferior average of 70.08 (IC95% 68.71-71.45), and a TSNIT Std. Deviation of 25.11 (IC95% 24.36-25.86). The results from the analysis for age were similar to the global results. Conclusions: Given the low level of cooperation required, GDx can be used without problem to study the retinal nerve fiber layer in 6-9-year-old children. GDx could provide objective information about the state of development of the retinal nerve fiber layer during this period of life

The scanning laser ophthalmoscope--a review of its role in bioscience and medicine.

The scanning laser ophthalmoscope (SLO) offers the potential for retinal imaging that is complementary both to that of the fundus camera and also the newly developing technique of optical coherence tomography (OCT). It has the ability to produce rapid images at low light levels using light of specific wavelengths. This permits temporal studies of fluorescent-labelled cells which offer a unique insight into inflammatory processes in the eye. The facility to image with several different wavelengths simultaneously offers the potential for spectral imaging of retinal tissue with the aim of revealing those early changes in tissue perfusion that indicate the onset of retinal disease, so increasing the probability of successful therapy.

Clinical trial of fundoscopy under general anesthesia for pediatric outpatients with retinoblastoma.

Retinoblastoma brings suffering, particularly to children. Formerly management during fundoscopy for children in Japan saw children's movements restricted with a blanket held by their parents or by nurses. This situation was sad, and the performance of the fundoscopy was limited because the children were crying and moving during the examination. After we received letters from the families of such children, we decided to introduce day-care general anesthesia for fundoscopy. After we investigated the current status of the treatment of retinoblastoma in leading countries, we carried out a trial of day-care general anesthesia for fundoscopy in 70 pediatric patients with retinoblastoma. We have now finished this first trial of day-care anesthesia, and we expect that discharge from hospital to places a longer distance away will be feasible.

Importancia de la valoración del fondo de ojo en el paciente hipertenso / Importance of fundoscopic examination in hypertensive patients

La hipertensión arterial (HTA) es el principal factor de riesgo para el desarrollo de enfermedades cardiovasculares y también de lesiones vasculares en la retina. Las alteraciones oculares de la HTA incluyen tres manifestaciones distintas e independientes en la retina, nervio óptico y circulación coroidal. El estudio oftalmológico realizado de forma habitual en todo paciente hipertenso ayuda a valorar la gravedad de la hipertensión. Las últimas guías de la European Society of Hypertension-European Society of Cardiology (ESH/ESC) incluyen el examen fundoscópico dentro de los métodos para evaluar la lesión de órgano diana en el paciente hipertenso. La existencia de hemorragias y exudados, signos de hipertensión maligna, obligará a realizar un tratamiento antihipertensivo más agresivo, a la vez que se llevan a cabo exploraciones complementarias. El reciente desarrollo de técnicas de fotografía del fondo de ojo ha permitido una precisa documentación de los signos microvasculares de la retina en la HTA en estudios realizados en población general. En numerosos estudios se ha comunicado la correlación entre las lesiones retinianas microvasculares, las lesiones de órgano diana y el desarrollo de diabetes, además de constituir un predictor independiente de ictus. En esta revisión se presentan las características de las lesiones oculares en la HTA, su clasificación y su correlación con la enfermedad cardiovascular (AU)

Three-dimensional confocal microscopy of the living human eye.

Three-dimensional confocal microscopy of the living eye is a major development in instrumentation for biomicroscopy of the eye. This noninvasive optical technology has its roots in the application of optics to reflected light imaging of the eye. These instrument developments began with Leeuwenhoek's use of his single lens microscope to investigate the structure of the eye. There followed a series of connected instruments: the ophthalmoscope, the slit lamp, the specular microscope, and the clinical confocal microscope. In vivo confocal microscopy produces high contrast, reflected light images or optical sections through the depth of living ocular tissue. Stacks of registered optical sections can be transformed by computer visualization techniques into three-dimensional volume images of ocular tissues: cornea, ocular lens, retina, and optic nerve. The clinical confocal microscope has resulted in new diagnostic techniques and new cellular descriptions of ocular disorders and pathology.

Evaluation of corneal topography: past, present and future trends.

The keratometer and photokeratoscope have long been the standard instruments for measuring corneal curvature. The recent development of computer-assisted photokeratoscopy has greatly enhanced the evaluation of corneal topography, helping improve our understanding of both normal and abnormal topography and their influence on visual acuity. The authors review normal corneal topography and compare various tools, both new and old, currently available for evaluating corneal contour. Case studies are presented to illustrate some of the clinical and research applications of computer-assisted photokeratoscopy in an ophthalmology practice. Future applications of computer-assisted photokeratoscopy include intraoperative topography, the design of custom-fitted contact lenses and combination with ray-tracing analysis.