Image quality assessment of retinal fundus photographs for diabetic retinopathy in the machine learning era: a review.

This study aimed to evaluate the image quality assessment (IQA) and quality criteria employed in publicly available datasets for diabetic retinopathy (DR). A literature search strategy was used to identify relevant datasets, and 20 datasets were included in the analysis. Out of these, 12 datasets mentioned performing IQA, but only eight specified the quality criteria used. The reported quality criteria varied widely across datasets, and accessing the information was often challenging. The findings highlight the importance of IQA for AI model development while emphasizing the need for clear and accessible reporting of IQA information. The study suggests that automated quality assessments can be a valid alternative to manual labeling and emphasizes the importance of establishing quality standards based on population characteristics, clinical use, and research purposes. In conclusion, image quality assessment is important for AI model development; however, strict data quality standards must not limit data sharing. Given the importance of IQA for developing, validating, and implementing deep learning (DL) algorithms, it's recommended that this information be reported in a clear, specific, and accessible way whenever possible. Automated quality assessments are a valid alternative to the traditional manual labeling process, and quality standards should be determined according to population characteristics, clinical use, and research purpose.

Exploring Patient Demographics and Presence of Retinal Vascular Disease in Paracentral Acute Middle Maculopathy.

PURPOSE: To investigate the sociodemographic profile, the association with retinal vascular diseases (RVD) and systemic comorbidities, and visual outcomes of patients with paracentral acute middle maculopathy (PAMM) in a large, ethnically diverse single-center cohort. DESIGN: Retrospective cohort study. METHODS: Electronic health record query for all patients presenting with PAMM at Moorfields Eye Hospital, London, was completed. Detailed demographic, clinical, and systemic information were collected and analyzed. RESULTS: A total of 78 eyes of 78 patients with confirmed PAMM were included in the study. Forty patients (51.3%) presented with no RVD, 20 patients (25.6%) with retinal vein occlusion (RVO), 16 patients (20.5%) with retinal artery occlusion (RAO), and 2 patients (2.6%) with concomitant RAO and RVO. Patients with PAMM+RAO were older than those with RVO (P = .02) and more likely to have a history of major adverse cardiovascular events (MACE) (P = .01), with a significantly worse presenting best corrected visual acuity (BCVA) (20/50) compared to patients with RVO (P = .02) and no RVD (P < .001). Individuals with isolated PAMM had a significantly higher prevalence of previous MACE (P = .04) and sickle cell disease (SCD) (P = .04) compared to those with RVO. At the last follow-up, 64 patients (85.3%) had a good BCVA (>20/32). CONCLUSIONS: The significant association of PAMM with RVD supports the hypothesis of an ischemic etiology. Individuals with isolated PAMM had a higher prevalence of MACE and SCD. Thus, it is important to prompt immediate referral for a comprehensive systemic evaluation. Across the whole cohort, PAMM was associated with good BCVA improvement during follow-up, indicating a good visual prognosis.

Teleophthalmology and retina: a review of current tools, pathways and services.

Telemedicine, the use of telecommunication and information technology to deliver healthcare remotely, has evolved beyond recognition since its inception in the 1970s. Advances in telecommunication infrastructure, the advent of the Internet, exponential growth in computing power and associated computer-aided diagnosis, and medical imaging developments have created an environment where telemedicine is more accessible and capable than ever before, particularly in the field of ophthalmology. Ever-increasing global demand for ophthalmic services due to population growth and ageing together with insufficient supply of ophthalmologists requires new models of healthcare provision integrating telemedicine to meet present day challenges, with the recent COVID-19 pandemic providing the catalyst for the widespread adoption and acceptance of teleophthalmology. In this review we discuss the history, present and future application of telemedicine within the field of ophthalmology, and specifically retinal disease. We consider the strengths and limitations of teleophthalmology, its role in screening, community and hospital management of retinal disease, patient and clinician attitudes, and barriers to its adoption.

Effects of three physical exercise modalities on respiratory function of older adults with Parkinson's disease: A randomized clinical trial.

INTRODUCTION: Deficits in respiratory function of patients with Parkinson's disease contribute to aspiration pneumonia, one of the main causes of mortality in this population. The aim of this study was to evaluate the effects of functional training, bicycle exercise, and exergaming on respiratory function of elderly with Parkinson's disease. METHODS: A randomized clinical trial with single blinding was conducted in a public reference outpatient clinic for the elderly. The participants were randomly assigned to three groups. Group 1 was submitted to functional training (n = 18); group 2 performed bicycle exercise (n = 20), and group 3 trained with Kinect Adventures exergames (n = 20). The sessions performed lasted 8 weeks with a frequency of three 50-min sessions per week. The primary outcome was the forced expiratory volume in the first second; and the secondary outcomes were forced vital capacity, peak expiratory flow, and maximum inspiratory and expiratory pressures. RESULTS: The interventions performed did not improve the forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow. However, group 2 improved (p = 0.03) maximum expiratory pressure (from 65.5cmH2O to 73.1cmH2O) (effect size 0.47), and group 3 increased (p = 0.03) maximum inspiratory pressure (from -61.3cmH2O to -71.6cmH2O) (effect size 0.53). CONCLUSIONS: No effect was found on lung volume, forced respiratory flow and capacity of the participants with Parkinson's disease submitted to three different modalities of motor training. However, bicycle exercise and exergaming have improved expiratory and inspiratory muscle strength, respectively. NCT02622737.

Risk and prevalence of oral cancer in patients with different types of lupus erythematosus: a systematic review and meta-analysis.

OBJECTIVE: The objective of this study was to assess the risk and prevalence of oral cancer in patients with systemic lupus erythematosus (SLE) or discoid lupus erythematosus (DLE). STUDY DESIGN: The review included observational cohort and cross-sectional studies that investigated the incidence or prevalence of oral cancer in adults with confirmed diagnoses of SLE or DLE. Studies were selected based on predefined eligibility criteria, including the use of specific diagnostic criteria for SLE and DLE. After searches in PubMed/MEDLINE, EMBASE, Scopus, Web of Science, LILACS, and LIVIVO databases and gray literature for relevant studies, the selection process was conducted by independent reviewers. RESULTS: A total of 5,545 articles were identified. After screening, 8 studies met the inclusion criteria. The pooled risk estimate indicated a significantly increased risk of oral cancer in patients with SLE (risk ratio = 2.69; 95% confidence interval, 1.75 to 4.16; I2 = 0%; P = .78) compared with the general population. The pooled prevalence of oral cancer in patients with DLE was 10% (95% ci, 0.03 to 0.13; I2 = 59%; P = .12). CONCLUSIONS: This review provides evidence supporting an elevated risk for individuals with SLE or DLE developing oral cancer. The findings highlight the importance of monitoring oral mucosa in patients with these conditions.

Proposal of a new slit-lamp shield for ophthalmic examination and assessment of its effectiveness using computational simulations / Avaliação da eficácia e proposta de um novo protetor de lâmpada de fenda durante exame oftálmico por meio de simulações computacionais

ABSTRACT Purpose: This study aimed to use computational models for simulating the movement of respiratory droplets when assessing the efficacy of standard slit-lamp shield versus a new shield designed for increased clinician comfort as well as adequate protection. Methods: Simulations were performed using the commercial software Star-CCM+. Respiratory droplets were assumed to be 100% water in volume fraction with particle diameter distribution represented by a geometric mean of 74.4 (±1.5 standard deviation) μm over a 4-min duration. The total mass of respiratory droplets expelled from patients' mouths and droplet accumulation on the manikin were measured under the following three conditions: with no slit-lamp shield, using the standard slit-lamp shield, and using our new proposed shield. Results: The total accumulated water droplet mass (kilogram) and percentage of expelled mass accumulated on the shield under the three aforementioned conditions were as follows: 5.84e-10 kg (28% of the total weight of particle emitted that settled on the manikin), 9.14e-13 kg (0.045%), and 3.19e-13 (0.015%), respectively. The standard shield could shield off 99.83% of the particles that would otherwise be deposited on the manikin, which is comparable to 99.95% for the proposed design. Conclusion: Slit-lamp shields are effective infection control tools against respiratory droplets. The proposed shield showed comparable effectiveness compared with conventional slit-lamp shields, but with potentially enhanced ergonomics for ophthalmologists during slit-lamp examinations.

RESUMO Introdução: Os oftalmologistas têm alto risco de contrair a doença do Coronavírus-19 devido à proximidade com os pacientes durante os exames com lâmpada de fenda. Usamos um modelo de computação para avaliar a eficácia das proteções para lâmpadas de fenda e propusemos uma nova proteção ergonomicamente projetada. Métodos: As simulações foram realizadas no software comercial Star-CCM +. Os aerossóis de gotículas foram considerados 100% de água em fração de volume com distribuição de diâmetro de partícula representada por uma média geométrica de 74,4 ± 1,5 (desvio padrão) μm ao longo de uma duração de quatro minutos. A massa total de gotículas de água acumulada no manequim e a massa expelida pela boca do paciente foram medidas em três condições diferentes: 1) Sem protetor de lâmpada de fenda, 2) com protetor padrão, 3) Com o novo protetor proposto. Resultados: A massa total acumulada das gotas de água (kg) e a porcentagem da massa expelida acumulada no escudo para cada uma das respectivas condições foram; 1) 5,84e-10 kg (28% do peso total da partícula emitida que assentou no manequim), 2) 9,14e-13 kg (0,045%), 3,19e-13 (0,015%). O escudo padrão foi capaz de proteger 99,83% das partículas que, de outra forma, teriam se depositado no manequim, o que é semelhante a 99,95% para o projeto proposto. Conclusão: Protetores com lâmpada de fenda são ferramentas eficazes de controle de infecção contra gotículas respiratórias. O protetor proposto mostrou eficácia comparável em comparação com os protetores de lâmpada de fenda convencionais, mas potencialmente oferece uma melhor ergonomia para oftalmologistas durante o exame de lâmpada de fenda.

Development and international validation of custom-engineered and code-free deep-learning models for detection of plus disease in retinopathy of prematurity: a retrospective study.

BACKGROUND: Retinopathy of prematurity (ROP), a leading cause of childhood blindness, is diagnosed through interval screening by paediatric ophthalmologists. However, improved survival of premature neonates coupled with a scarcity of available experts has raised concerns about the sustainability of this approach. We aimed to develop bespoke and code-free deep learning-based classifiers for plus disease, a hallmark of ROP, in an ethnically diverse population in London, UK, and externally validate them in ethnically, geographically, and socioeconomically diverse populations in four countries and three continents. Code-free deep learning is not reliant on the availability of expertly trained data scientists, thus being of particular potential benefit for low resource health-care settings. METHODS: This retrospective cohort study used retinal images from 1370 neonates admitted to a neonatal unit at Homerton University Hospital NHS Foundation Trust, London, UK, between 2008 and 2018. Images were acquired using a Retcam Version 2 device (Natus Medical, Pleasanton, CA, USA) on all babies who were either born at less than 32 weeks gestational age or had a birthweight of less than 1501 g. Each images was graded by two junior ophthalmologists with disagreements adjudicated by a senior paediatric ophthalmologist. Bespoke and code-free deep learning models (CFDL) were developed for the discrimination of healthy, pre-plus disease, and plus disease. Performance was assessed internally on 200 images with the majority vote of three senior paediatric ophthalmologists as the reference standard. External validation was on 338 retinal images from four separate datasets from the USA, Brazil, and Egypt with images derived from Retcam and the 3nethra neo device (Forus Health, Bengaluru, India). FINDINGS: Of the 7414 retinal images in the original dataset, 6141 images were used in the final development dataset. For the discrimination of healthy versus pre-plus or plus disease, the bespoke model had an area under the curve (AUC) of 0·986 (95% CI 0·973-0·996) and the CFDL model had an AUC of 0·989 (0·979-0·997) on the internal test set. Both models generalised well to external validation test sets acquired using the Retcam for discriminating healthy from pre-plus or plus disease (bespoke range was 0·975-1·000 and CFDL range was 0·969-0·995). The CFDL model was inferior to the bespoke model on discriminating pre-plus disease from healthy or plus disease in the USA dataset (CFDL 0·808 [95% CI 0·671-0·909, bespoke 0·942 [0·892-0·982]], p=0·0070). Performance also reduced when tested on the 3nethra neo imaging device (CFDL 0·865 [0·742-0·965] and bespoke 0·891 [0·783-0·977]). INTERPRETATION: Both bespoke and CFDL models conferred similar performance to senior paediatric ophthalmologists for discriminating healthy retinal images from ones with features of pre-plus or plus disease; however, CFDL models might generalise less well when considering minority classes. Care should be taken when testing on data acquired using alternative imaging devices from that used for the development dataset. Our study justifies further validation of plus disease classifiers in ROP screening and supports a potential role for code-free approaches to help prevent blindness in vulnerable neonates. FUNDING: National Institute for Health Research Biomedical Research Centre based at Moorfields Eye Hospital NHS Foundation Trust and the University College London Institute of Ophthalmology. TRANSLATIONS: For the Portuguese and Arabic translations of the abstract see Supplementary Materials section.

Proposal of a new slit-lamp shield for ophthalmic examination and assessment of its effectiveness using computational simulations.

PURPOSE: This study aimed to use computational models for simulating the movement of respiratory droplets when assessing the efficacy of standard slit-lamp shield versus a new shield designed for increased clinician comfort as well as adequate protection. METHODS: Simulations were performed using the commercial software Star-CCM+. Respiratory droplets were assumed to be 100% water in volume fraction with particle diameter distribution represented by a geometric mean of 74.4 (±1.5 standard deviation) µm over a 4-min duration. The total mass of respiratory droplets expelled from patients' mouths and droplet accumulation on the manikin were measured under the following three conditions: with no slit-lamp shield, using the standard slit-lamp shield, and using our new proposed shield. RESULTS: The total accumulated water droplet mass (kilogram) and percentage of expelled mass accumulated on the shield under the three aforementioned conditions were as follows: 5.84e-10 kg (28% of the total weight of particle emitted that settled on the manikin), 9.14e-13 kg (0.045%), and 3.19e-13 (0.015%), respectively. The standard shield could shield off 99.83% of the particles that would otherwise be deposited on the manikin, which is comparable to 99.95% for the proposed design. Conclusion: Slit-lamp shields are effective infection control tools against respiratory droplets. The proposed shield showed comparable effectiveness compared with conventional slit-lamp shields, but with potentially enhanced ergonomics for ophthalmologists during slit-lamp examinations.

Efficacy of smartphone-based retinal photography by undergraduate students in screening and early diagnosing diabetic retinopathy.

BACKGROUND: To evaluate the efficacy of retinal photography obtained by undergraduate students using a smartphone-based device in screening and early diagnosing diabetic retinopathy (DR). METHODS: We carried out an open prospective study with ninety-nine diabetic patients (194 eyes), who were submitted to an ophthalmological examination in which undergraduate students registered images of the fundus using a smartphone-based device. At the same occasion, an experienced nurse captured fundus photographs from the same patients using a gold standard tabletop camera system (Canon CR-2 Digital Non-Mydriatic Retinal Camera), with a 45º field of view. Two distinct masked specialists evaluated both forms of imaging according to the presence or absence of sings of DR and its markers of severity. We later compared those reports to assess agreement between the two technologies. RESULTS: Concerning the presence or absence of DR, we found an agreement rate of 84.07% between reports obtained from images of the smartphone-based device and from the regular (tabletop) fundus camera; Kappa: 0.67; Sensitivity: 71.0% (Confidence Interval [CI]: 65.05-78.16%); Specificity: 94.06% (CI: 90.63-97.49%); Accuracy: 84.07%; Positive Predictive Value (PPV): 90.62%; Negative Predictive Value (NPV): 80.51%. As for the classification between proliferative diabetic retinopathy and non-proliferative diabetic retinopathy, we found an agreement of 90.00% between the reports; Kappa: 0.78; Sensitivity: 86.96%; (CI: 79.07-94.85%); Specificity: 91.49% (CI: 84.95-98.03%); Accuracy: 90.00%; PPV: 83.33%; NPV: 93.48%. Regarding the degree of classification of DR, we found an agreement rate of 69.23% between the reports; Kappa: 0.52. As relating to the presence or absence of hard macular exudates, we found an agreement of 84.07% between the reports; Kappa: 0.67; Sensitivity: 71.60% (CI: 65.05-78.16%); Specificity: 94.06% (CI: 90.63-97.49%); Accuracy: 84.07%; PPV: 90.62%; NPV: 80.51%. CONCLUSION: The smartphone-based device showed promising accuracy in the detection of DR (84.07%), making it a potential tool in the screening and early diagnosis of DR.

Thanatology in the northern muriqui (Brachyteles hypoxanthus).

Primate thanatology, or the study of primate responses to dying and death, has become increasingly relevant in recent years. However, the number of reports remains small and the quality of published records is highly variable. Here, we extend the literature on comparative thanatology with observations on a population of the northern muriqui (Brachyteles hypoxanthus). We compiled all seven cases of muriqui responses to dead, dying, or abandoned infants observed by trained researchers of the Muriqui Project of Caratinga between 1998 and 2020. Four different adult females were observed carrying their dead offspring (n = 4) and one of these females was also observed carrying her dead grand-offspring (n = 1). Five of the seven cases involved dead newborns, one involved a newborn abandoned by its mother on the forest floor, and one involved a 1.6-year-old infant that was visibly ill and died after its mother left it on the ground. Dead newborns were carried for 1-3 days, and all cases occurred during the dry season months. No other age-sex classes were observed to interact with the dead or dying immatures. Our observations are consistent with hypotheses concerning the predominance of dead-infant carrying in other primates, and with the effects of climate on rates of corpse disintegration. They also show the value of long-term studies for obtaining and understanding anecdotal records of rare behavior.

AMAZONIA CAMTRAP: A data set of mammal, bird, and reptile species recorded with camera traps in the Amazon forest.

The Amazon forest has the highest biodiversity on Earth. However, information on Amazonian vertebrate diversity is still deficient and scattered across the published, peer-reviewed, and gray literature and in unpublished raw data. Camera traps are an effective non-invasive method of surveying vertebrates, applicable to different scales of time and space. In this study, we organized and standardized camera trap records from different Amazon regions to compile the most extensive data set of inventories of mammal, bird, and reptile species ever assembled for the area. The complete data set comprises 154,123 records of 317 species (185 birds, 119 mammals, and 13 reptiles) gathered from surveys from the Amazonian portion of eight countries (Brazil, Bolivia, Colombia, Ecuador, French Guiana, Peru, Suriname, and Venezuela). The most frequently recorded species per taxa were: mammals: Cuniculus paca (11,907 records); birds: Pauxi tuberosa (3713 records); and reptiles: Tupinambis teguixin (716 records). The information detailed in this data paper opens up opportunities for new ecological studies at different spatial and temporal scales, allowing for a more accurate evaluation of the effects of habitat loss, fragmentation, climate change, and other human-mediated defaunation processes in one of the most important and threatened tropical environments in the world. The data set is not copyright restricted; please cite this data paper when using its data in publications and we also request that researchers and educators inform us of how they are using these data.

Evaluation of contrast sensitivity in non-high-risk proliferative diabetic retinopathy treated with panretinal photocoagulation with and without intravitreal injections of ranibizumab / Avaliação da sensibilidade ao contraste em retinopatia diabética proliferativa de não alto risco tratada com panfotocoagulação retiniana com ou sem injeções intravítrea de ranibizumabe

ABSTRACT Purpose: To evaluate contrast sensitivity in non-high-risk, treatment-naïve proliferative diabetic retinopathy patients treated with panretinal photocoagulation and intravitreal injections of ranibizumab) versus panretinal photocoagulation alone. Methods: Sixty eyes of 30 patients with bilateral proliferative diabetic retinopathy were randomized into two groups: one received panretinal photocoagulation and ranibizumab injections (study group), while the other received panretinal photocoagulation alone (control group). All eyes were treated with panretinal photocoagulation in three sessions according to the Early Treatment Diabetic Retinopathy Study guidelines. Contrast sensitivity measurements were performed under photopic conditions (85 cd/m2) with the Visual Contrast Test Sensitivity 6500 chart, allowing for the evaluation of five spatial frequencies with sine wave grating charts: 1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (cpd). Outcomes were measured in contrast sensitivity threshold scores among and within groups, from baseline to 1, 3, and 6 months. Results: Fifty-eight eyes (28 in the study group and 30 in the control group) reached the study endpoint. A comparative analysis of changes in contrast sensitivity between the groups showed significant differences mainly in low frequencies as follows: at month 1 in 1.5 cpd (p=0.001) and 3.0 cpd (p=0.04); at month 3 in 1.5 cpd (p=0.016), and at month 6 in 1.5 cpd (p=0.001) and 3.0 cpd (p=0.026) in favor of the study group. Conclusions: In eyes of patients with non-high-risk proliferative diabetic retinopathy, panretinal photocoagulation treatment with ranibizumab appears to cause less damage to contrast sensitivity compared with panretinal photocoagulation treatment alone. Thus, our evaluation of contrast sensitivity may support the use of ranabizumab as an adjuvant to panretinal photocoagulation for the treatment of proliferative diabetic retinopathy.

RESUMO Objetivos: Avaliar a sensibilidade ao contraste em pacientes virgens de tratamento com retinopatia diabética proliferativa de não alto risco, submetidos a panfotocoagulação retiniana com injeções intravítreas de ranibizumabe versus pan­fotocoagulação isolada. Métodos: Sessenta olhos de 30 pa­cientes foram randomizados em dois grupos: um submetido a panfotocoagulação com injeções de ranibizumabe (grupo estudo), e o outro submetimedo a panfotocoagulação isolada (grupo controle). Todos olhos foram tratados em 3 sessões de laser, seguindo recomendação do Early Treatment Diabetic Retinopathy Study (ETDRS). Avaliação da sensibilidade ao contraste foi realizada sob condições fotópicas (85 cd/m2) com tabela Visual Contrast Test Sensitivity 6500, permitindo avaliação de cinco frequências espaciais medidas com redes senoidais: 1.5, 3.0, 6.0, 12.0 e 18.0 ciclos por grau de ângulo visual (cpd). Foram realizadas medidas dos limiares de sensibilidade ao contraste intra e entre grupos na visita inicial, no 1º, 3º, e 6º mês de seguimento. Resultados: Cinquenta e oito olhos, 28 do grupo estudo e 30 do grupo controle, atingiram o término do estudo. Análise comparativa da SC entre os grupos mostrou diferença estatisticamente significante, nas baixas frequências espaciais, no 1º mês em 1.5 cpd (p=0,001) e 3.0 cpd (p=0,04), no 3º mês em 1.5 cpd (p=0,016) e no 6º mês em 3.0 cpd (p=0,026) a favor do grupo estudo. Conclusão: O tratamento com panfotocoagulação associada a injeção de ranibizumabe parece causar menos danos a sensibilidade ao contraste quando comparada com panfotocoagulação isolada em olhos com retinopatia diabética proliferativa de não alto risco. Dessa forma, os resultados apresentados podem justificar a associação do ranibizumabe à panfotocoagulação nestes pacientes.

Diabetic retinopathy classification for supervised machine learning algorithms.

BACKGROUND: Artificial intelligence and automated technology were first reported more than 70 years ago and nowadays provide unprecedented diagnostic accuracy, screening capacity, risk stratification, and workflow optimization. Diabetic retinopathy is an important cause of preventable blindness worldwide, and artificial intelligence technology provides precocious diagnosis, monitoring, and guide treatment. High-quality exams are fundamental in supervised artificial intelligence algorithms, but the lack of ground truth standards in retinal exams datasets is a problem. MAIN BODY: In this article, ETDRS, NHS, ICDR, SDGS diabetic retinopathy grading, and manual annotation are described and compared in publicly available datasets. The various DR labeling systems generate a fundamental problem for AI datasets. Possible solutions are standardization of DR classification and direct retinal-finding identifications. CONCLUSION: Reliable labeling methods also need to be considered in datasets with more trustworthy labeling.

Diabetic Retinopathy Screening Using Artificial Intelligence and Handheld Smartphone-Based Retinal Camera.

BACKGROUND: Portable retinal cameras and deep learning (DL) algorithms are novel tools adopted by diabetic retinopathy (DR) screening programs. Our objective is to evaluate the diagnostic accuracy of a DL algorithm and the performance of portable handheld retinal cameras in the detection of DR in a large and heterogenous type 2 diabetes population in a real-world, high burden setting. METHOD: Participants underwent fundus photographs of both eyes with a portable retinal camera (Phelcom Eyer). Classification of DR was performed by human reading and a DL algorithm (PhelcomNet), consisting of a convolutional neural network trained on a dataset of fundus images captured exclusively with the portable device; both methods were compared. We calculated the area under the curve (AUC), sensitivity, and specificity for more than mild DR. RESULTS: A total of 824 individuals with type 2 diabetes were enrolled at Itabuna Diabetes Campaign, a subset of 679 (82.4%) of whom could be fully assessed. The algorithm sensitivity/specificity was 97.8 % (95% CI 96.7-98.9)/61.4 % (95% CI 57.7-65.1); AUC was 0·89. All false negative cases were classified as moderate non-proliferative diabetic retinopathy (NPDR) by human grading. CONCLUSIONS: The DL algorithm reached a good diagnostic accuracy for more than mild DR in a real-world, high burden setting. The performance of the handheld portable retinal camera was adequate, with over 80% of individuals presenting with images of sufficient quality. Portable devices and artificial intelligence tools may increase coverage of DR screening programs.

Evaluation of contrast sensitivity in non-high-risk proliferative diabetic retinopathy treated with panretinal photocoagulation with and without intravitreal injections of ranibizumab.

PURPOSE: To evaluate contrast sensitivity in non-high-risk, treatment-naïve proliferative diabetic retinopathy patients treated with panretinal photocoagulation and intravitreal injections of ranibizumab) versus panretinal photocoagulation alone. METHODS: Sixty eyes of 30 patients with bilateral proliferative diabetic retinopathy were randomized into two groups: one received panretinal photocoagulation and ranibizumab injections (study group), while the other received panretinal photocoagulation alone (control group). All eyes were treated with panretinal photocoagulation in three sessions according to the Early Treatment Diabetic Retinopathy Study guidelines. Contrast sensitivity measurements were performed under photopic conditions (85 cd/m2) with the Visual Contrast Test Sensitivity 6500 chart, allowing for the evaluation of five spatial frequencies with sine wave grating charts: 1.5, 3.0, 6.0, 12.0, and 18.0 cycles per degree (cpd). Outcomes were measured in contrast sensitivity threshold scores among and within groups, from baseline to 1, 3, and 6 months. RESULTS: Fifty-eight eyes (28 in the study group and 30 in the control group) reached the study endpoint. A comparative analysis of changes in contrast sensitivity between the groups showed significant differences mainly in low frequencies as follows: at month 1 in 1.5 cpd (p=0.001) and 3.0 cpd (p=0.04); at month 3 in 1.5 cpd (p=0.016), and at month 6 in 1.5 cpd (p=0.001) and 3.0 cpd (p=0.026) in favor of the study group. CONCLUSIONS: In eyes of patients with non-high-risk proliferative diabetic retinopathy, panretinal photocoagulation treatment with ranibizumab appears to cause less damage to contrast sensitivity compared with panretinal photocoagulation treatment alone. Thus, our evaluation of contrast sensitivity may support the use of ranabizumab as an adjuvant to panretinal photocoagulation for the treatment of proliferative diabetic retinopathy.

Re-evaluating diabetic papillopathy using optical coherence tomography and inner retinal sublayer analysis.

BACKGROUND/OBJECTIVES: To re-evaluate diabetic papillopathy using optical coherence tomography (OCT) for quantitative analysis of the peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell layer (mGCL) and inner nuclear layer (mINL) thickness. SUBJECTS/METHODS: In this retrospective observational case series between June 2008 and July 2019 at Moorfields Eye hospital, 24 eyes of 22 patients with diabetes and optic disc swelling with confirmed diagnosis of NAION or diabetic papillopathy by neuro-ophthalmological assessment were included for evaluation of the pRNFL, mGCL and mINL thicknesses after resolution of optic disc swelling. RESULTS: The mean age of included patients was 56.5 (standard deviation (SD) ± 14.85) years with a mean follow-up duration of 216 days. Thinning of pRNFL (mean: 66.26, SD ± 31.80 µm) and mGCL (mean volume: 0.27 mm3, SD ± 0.09) were observed in either group during follow-up, the mINL volume showed no thinning with 0.39 ± 0.05 mm3. The mean decrease in visual acuity was 4.13 (SD ± 14.27) ETDRS letters with a strong correlation between mGCL thickness and visual acuity (rho 0.74, p < 0.001). CONCLUSION: After resolution of acute optic disc swelling, atrophy of pRNFL and mGCL became apparent in all cases of diabetic papillopathy and diabetic NAION, with preservation of mINL volumes. Analysis of OCT did not provide a clear diagnostic distinction between both entities. We suggest a diagnostic overlay with the degree of pRNFL and mGCL atrophy of prognostic relevance for poor visual acuity independent of the semantics of terminology.

Diagnostic ability of confocal near-infrared reflectance fundus imaging to detect retrograde microcystic maculopathy from chiasm compression. A comparative study with OCT findings.

PURPOSE: To evaluate the ability of confocal near-infrared reflectance (NIR) to diagnose retrograde microcystic maculopathy (RMM) in eyes with temporal visual field (VF) loss and optic atrophy from chiasmal compression. To compare NIR findings with optical coherence tomography (OCT) findings in the same group of patients. METHODS: Thirty-four eyes (26 patients) with temporal VF loss from chiasmal compression and 41 healthy eyes (22 controls) underwent NIR fundus photography, and macular OCT scanning. VF loss was estimated and retinal layers thickness were measured on OCT. Two examiners blinded to the diagnosis randomly examined NIR images for the presence of hyporeflective abnormality (HA) and OCT scans for the presence of microcystic macular abnormalities (MMA). The total average and hemi-macular HA area and number of microcysts were determined. The groups were compared and the level of agreement was estimated. RESULTS: The OCT-measured macular retinal nerve fiber and ganglion cell layers were thinner and the inner nuclear layer was thicker in patients compared to controls. HA and MMA were detected in 22 and 12 patient eyes, respectively, and in 0 controls (p<0.001, both comparisons). HA was significantly more frequent than MMA in patients with optic atrophy, and agreement between HA and MMA (both total and hemi-macular) was fair (kappa range: 0.24-0.29). The mean HA area was significantly greater in the nasal than temporal hemi-macula. A re-analysis of the 14 eyes with discrepant findings allowed to confirm RMM in 20 eyes (20/34) indicating that OCT detected RMM in 12 and missed it in 8 eyes. On the other hand, NIR correctly detected 18 out of 20 eyes, overcalled 4 and missed 2. CONCLUSIONS: RMM is a frequent finding in eyes with severe VF loss from long-standing chiasmal compression. NIR photography appears to be more sensitive than OCT for detecting RMM and may be useful as screening method for its presence.

Disfunções sexuais em mulheres jovens universitárias: estudo transversal / Sexual dysfunctions in young university women: a cross-sectional study

OBJETIVO: Verificar a frequência e os fatores associados à disfunção sexual em mulheres jovens universitárias. MÉTODOS: Trata-se de um estudo descritivo analítico de corte transversal. Participaram deste estudo 111 mulheres, estudantes, heterossexuais do curso de fisioterapia da Universidade Federal da Bahia. Cada participante respondeu a dois questionários autoaplicáveis "Investigação de fatores associados" e "Quociente sexual ­ versão feminina", entre os meses de setembro e outubro de 2019. RESULTADOS: Foi encontrado nesta população prevalência de 8% de disfunção sexual. O sintoma de esforço evacuatório esteve associado a pior desempenho/satisfação sexual pelo score total do QS-F (p=0,03), e quando avaliado por agrupamento de questões, foi encontrada associação entre esforço evacuatório e pior excitação (p=0,01), esforço evacuatório e mais dor (p=0,04); urgência urinária e mais dor (p=0,04); violência e pior excitação (p=0,05) e violência e menos satisfação/orgasmo (p=0,02). CONCLUSÃO: Os resultados sugerem que há baixa prevalência de disfunção sexual na população estudada, mas há associação entre sintomas de disfunções do assoalho pélvico e disfunções sexuais em mulheres jovens.

OBJECTIVE: To estimate the prevalence of sexual dysfunction in young college women. METHODS: This is a descriptive-analytical cross-sectional study. A total of 111 heterosexual women students of the physiotherapy course from the Universidade Federal da Bahia participated in this study. Each participant answered two self-administered questionnaires, "Investigation of associated factors" and "Sex ratio - female version" between September and October 2019. RESULTS: A prevalence of 8% of sexual dysfunction was found in this population. The symptom of evacuatory effort was associated with worse performance / sexual satisfaction by the total SQ-F score (p=0.03), and when assessed by a grouping of questions, an association was found between evacuatory effort and worse arousal (p=0.01), evacuatory effort, and pain (p=0.04); urinary urgency and pain (p=0.04); violence and arousal (p=0.05); and violence and less satisfaction/orgasm (p=0.02). CONCLUSION: The results suggest a low prevalence of sexual dysfunction in the studied population, but there is an association between symptoms of pelvic floor dysfunction and sexual dysfunction in young women.