Portable color retinography findings in COVID-19 patients admitted to the ward.

Retinal lesions, including cotton-wool exudates, microbleeds, vascular occlusions and vasculitis, occur in a minority of Coronavirus Disease-19 (COVID-19) patients. Retinal assessments using retinography can help document these lesions. The objective of this work was to identify retinal changes in patients admitted to the ward with a positive Real Time Quantitative Polymerase Chain Reaction (RT-qPCR) exam for COVID-19. A cross-sectional, observational study was carried out of patients with mild and moderate symptoms admitted to the Hospital de Base in São José do Rio Preto. The Eyer® portable retinal camera (Phelcom® Technologies) was used to evaluate 30 male and 21 female patients. The ages ranged from 21 to 83 years (mean: 47 years). Systemic arterial hypertension was identified in 21 (41.2 %) and diabetes mellitus in 12 (23.5 %) patients. Six (11.7 %) reported worsening visual acuity, however, none of these patients had ocular findings to justify this complaint. Ten patients (19.6 %) had intraretinal hemorrhages; one (1.9 %) had cotton-wool exudates and seven (13.7 %) had dilations of veins. Thirteen patients (25.4 %) had vascular tortuosity and six (11.7 %) had pathological arteriovenous crossings. Portable retinography is useful to evaluate patients admitted to isolation wards due to COVID-19. It is important to remember that some of the patients investigated had comorbidities like diabetic maculopathy and systemic arterial hypertension. Hence, some care should be taken in attributing these observations uniquely to COVID-19 infection.

A Radiomic-Based Machine Learning System to Diagnose Age-Related Macular Degeneration from Ultra-Widefield Fundus Retinography.

The present study was conducted to investigate the potential of radiomics to develop an explainable AI-based system to be applied to ultra-widefield fundus retinographies (UWF-FRTs) with the objective of predicting the presence of the early signs of Age-related Macular Degeneration (AMD) and stratifying subjects with low- versus high-risk of AMD. The ultimate aim was to provide clinicians with an automatic classifier and a signature of objective quantitative image biomarkers of AMD. The use of Machine Learning (ML) and radiomics was based on intensity and texture analysis in the macular region, detected by a Deep Learning (DL)-based macular detector. Two-hundred and twenty six UWF-FRTs were retrospectively collected from two centres and manually annotated to train and test the algorithms. Notably, the combination of the ML-based radiomics model and the DL-based macular detector reported 93% sensitivity and 74% specificity when applied to the data of the centre used for external testing, capturing explainable features associated with drusen or pigmentary abnormalities. In comparison to the human operator's annotations, the system yielded a 0.79 Cohen κ, demonstrating substantial concordance. To our knowledge, these results are the first provided by a radiomic approach for AMD supporting the suitability of an explainable feature extraction method combined with ML for UWF-FRT.

Retinopatia hipertensiva - relação com o tempo de diagnóstico da hipertensão arterial sistêmica / Hypertensive retinopathy - relation with time of diagnosis of hypertension / Retinopatía hipertensiva - relación con el tiempo de diagnóstico de hipertensión arterial sistémica

Introdução: Hipertensão arterial sistêmica é uma condição em que a pressão do sangue contra as paredes das artérias é muito elevada. O olho, diretamente envolvido no aumento da resistência vascular periférica, é orgão-alvo quando a retinopatia hipertensiva se faz presente. O controle da hipertensão arterial sistêmica desempenha papel fundamental na evolução da retinopatia hipertensiva, considerando o tempo de duração e a idade dos pacientes. Fundoscopia é o exame mais importante para visualizar esses pequenos vasos, sendo possível detectar alterações e classificar a hipertensão arterial sistêmica para uma melhor conduta terapêutica. As alterações vasculares retinianas visualizadas no fundo do olho são classificadas na hipertensão arterial sistêmica em arterioescleróticas e hipertensivas. Objetivo: Identificar os principais fatores relacionados à retinopatia hipertensiva e a relação com o tempo de diagnóstico de hipertensão arterial sistêmica. Método: Estudo transversal, observacional e descritivo. Fundoscopia e Retinografia foram realizados em pacientes do ambulatório de oftalmologia de um hospital-escola no interior paulista, com diagnóstico de hipertensão arterial sistêmica, para avaliar o grau de comprometimento vascular retiniano. Resultados: Foram examinados 236 olhos de 118 pacientes, a maioria do sexo feminino (58,5%), com idade média de 61 anos. Questionados sobre o controle da sua hipertensão arterial sistêmica, as respostas obtidas foram: 48 pacientes (40,7%) souberam responder que sua pressão era controlada com medicação; 60 (50,9%) afirmaram descontrole da pressão sistêmica e 10 (8,4%) não souberam responder. Dos 103 pacientes (88%) que apresentaram alterações na Fundoscopia, 70% apresentaram alterações relacionadas a arteriosclerose e 76 (64%) relacionados à retinopatia hipertensiva. Dos pacientes com arteriosclerose, 74,7% apresentaram alteração no cruzamento arteriovenoso, enquanto os pacientes com retinopatia hipertensiva 51,3% apresentaram vasoconstrição arteriolar espástica. A abordagem terapêutica da HAS é baseada na tentativa de controle dos valores pressóricos e a adesão ao tratamento é um fator fundamental para o manejo de condições e a prevenção de complicações decorrentes delas. Conclusão: Os fatores diagnósticos relacionados à retinopatia hipertensiva foram: o tempo diagnóstico, as alterações vasculares de arterioloesclerose e o descontrole pressórico. As alterações na retinografia servem para auxiliar na gravidade de hipertensão arterial sistêmica bem como alertar e estimular à ter um melhor controle de PA. O envolvimento de toda a equipe de saúde também é necessário para uma visão multidisciplinar do problema, já que a adesão ao tratamento é importante no controle da hipertensão arterial sistêmica

Introduction: Systemic arterial hypertension is a condition in which blood pressure against the walls of the arteries is very high. The eye, directly involved in increasing peripheral vascular resistance, is the target organ when hypertensive retinopathy is present. The control of systemic arterial hypertension plays a fundamental role in the evolution of hypertensive retinopathy, considering the duration and age of the patients. Fundoscopy is the most important exam to visualize these small vessels, making it possible to detect changes and classify systemic arterial hypertension for better therapeutic management. Retinal vascular changes seen in the fundus of the eye are classified in systemic arterial hypertension into arteriosclerotic and hypertensive. Objective: To identify the main factors related to hypertensive retinopathy and the relationship with the time of diagnosis of systemic arterial hypertension. Method: Cross-sectional, observational and descriptive study. Fundoscopy and retinography were performed on patients at the ophthalmology outpatient clinic of a teaching hospital in the interior of São Paulo, diagnosed with systemic arterial hypertension, to assess the degree of retinal vascular compromise. Results: 236 eyes of 118 patients were examined, the majority of them female (58.5%), with a mean age of 61 years. When asked about the control of their systemic arterial hypertension, the answers obtained were: 48 patients (40.7%) were able to answer that their pressure was controlled with medication; 60 (50.9%) stated that they had uncontrolled systemic pressure and 10 (8.4%) were unable to answer. Of the 103 patients (88%) who presented changes on Fundoscopy, 70% presented changes related to arteriosclerosis and 76 (64%) related to hypertensive retinopathy. Of the patients with arteriosclerosis, 74.7% presented changes in arteriovenous crossing, while 51.3% of patients with hypertensive retinopathy presented spastic arteriolar vasoconstriction. The therapeutic approach to SAH is based on trying to control blood pressure values and adherence to treatment is a fundamental factor in managing conditions and preventing complications resulting from them. Conclusion: The diagnostic factors related to hypertensive retinopathy were: time of diagnosis, vascular alterations of arteriolosclerosis and lack of blood pressure control. Changes in retinography serve to help with the severity of systemic arterial hypertension as well as alert and encourage better BP control. The involvement of the entire healthcare team is also necessary for a multidisciplinary view of the problem, as adherence to treatment is important in controlling systemic arterial hypertension

Introducción: La hipertensión arterial sistémica es una condición en la que la presión arterial contra las paredes de las arterias es muy alta. El ojo, directamente implicado en el aumento de la resistencia vascular periférica, es el órgano diana cuando hay retinopatía hipertensiva. El control de la hipertensión arterial sistémica juega un papel fundamental en la evolución de la retinopatía hipertensiva, considerando la duración y edad de los pacientes. La fundoscopia es el examen más importante para visualizar estos pequeños vasos, permitiendo detectar cambios y clasificar la hipertensión arterial sistémica para un mejor manejo terapéutico. Los cambios vasculares retinianos observados en el fondo del ojo se clasifican en la hipertensión arterial sistémica en arteriosclerótica e hipertensiva. Objetivo: Identificar los principales factores relacionados con la retinopatía hipertensiva y la relación con el momento del diagnóstico de la hipertensión arterial sistémica. Método: Estudio transversal, observacional y descriptivo. Se realizaron fundoscopia y retinografía a pacientes del ambulatorio de oftalmología de un hospital universitario del interior de São Paulo, diagnosticados con hipertensión arterial sistémica, para evaluar el grado de compromiso vascular retiniano. Resultados: Se examinaron 236 ojos de 118 pacientes, la mayoría del sexo femenino (58,5%), con una edad media de 61 años. Al preguntarles sobre el control de su hipertensión arterial sistémica, las respuestas obtenidas fueron: 48 pacientes (40,7%) pudieron responder que su presión estaba controlada con medicamentos; 60 (50,9%) afirmaron tener presión sistémica descontrolada y 10 (8,4%) no supieron responder. De los 103 pacientes (88%) que presentaron cambios en la fundoscopia, el 70% presentó cambios relacionados con arteriosclerosis y 76 (64%) relacionados con retinopatía hipertensiva. De los pacientes con arteriosclerosis, el 74,7% presentó cambios en el cruce arteriovenoso, mientras que el 51,3% de los pacientes con retinopatía hipertensiva presentaron vasoconstricción arteriolar espástica. El abordaje terapéutico de la HAS se basa en intentar controlar los valores de presión arterial y la adherencia al tratamiento es un factor fundamental para el manejo de las afecciones y la prevención de complicaciones derivadas de las mismas. Conclusión: Los factores diagnósticos relacionados con la retinopatía hipertensiva fueron: momento del diagnóstico, alteraciones vasculares de la arteriolosclerosis y falta de control de la presión arterial. Los cambios en la retinografía sirven para ayudar con la gravedad de la hipertensión arterial sistémica, así como para alertar y fomentar un mejor control de la PA. También es necesaria la implicación de todo el equipo sanitario para una visión multidisciplinar del problema, ya que la adherencia al tratamiento es importante en el control de la hipertensión arterial sistémica

Edad retiniana como biomarcador predictivo del grado de retinopatía diabética / Retinal age as a predictive biomarker of the diabetic retinopathy grade

Objetivo Aplicar técnicas de inteligencia artificial, mediante algoritmos de aprendizaje profundo, para el desarrollo y optimización de un sistema de predicción de la edad de una persona con base en una retinografía color, y estudiar una posible relación entre la evolución de la retinopatía diabética (RD) y un envejecimiento prematuro de la retina. Métodos Se entrenó una red convolucional para calcular la edad de una persona con base en una retinografía. Dicho entrenamiento fue realizado sobre un conjunto de retinografías de pacientes con diabetes previamente dividido en 3 subconjuntos (entrenamiento, validación y test). La diferencia entre la edad cronológica del paciente y la edad biológica de la retina se definió como gap de edad retiniano. Resultados Se utilizó un conjunto de 98.400 imágenes para la fase de entrenamiento, 1.000 imágenes para la fase de validación y 13.544 para la fase de test. El gap retiniano de los pacientes sin RD fue de 0,609 años y el de los pacientes con RD de 1,905 años (p<0,001), siendo la distribución por grado de RD de: RD leve 1,541 años; RD moderada 3,017 años; RD severa 3,117 años, y RD proliferativa 8,583 años. Conclusiones El gap de edad retiniano muestra una diferencia en positivo de media entre las personas diabéticas con RD frente a las que no tienen RD, y además aumenta progresivamente, de acuerdo con el grado de RD. Estos resultados podrían indicar la existencia de una relación entre la evolución de la enfermedad y un envejecimiento prematuro de la retina (AU)

Objective To apply artificial intelligence techniques, through deep learning algorithms, for the development and optimization of a system for predicting the age of a person based on a color retinography, and to study a possible relationship between the evolution of retinopathy diabetes (RD) and premature aging of the retina. Methods A convolutional network was trained to calculate the age of a person based on a retinography. Said training was carried out on a set of retinographies of patients with diabetes previously divided into 3 subsets (training, validation and test). The difference between the chronological age of the patient and the biological age of the retina was defined as the retinal age gap. Results A set of 98,400 images was used for the training phase, 1000 images for the validation phase and 13,544 for the test phase. The retinal gap of the patients without RD was 0.609 years and that of the patients with RD was 1905 years (p<0.001), with the distribution by degree of RD being: mild RD 1541 years; moderate RD 3017 years; RD severe 3117 years, and proliferative RD 8583 years. Conclusions The retinal age gap shows a positive mean difference between diabetics with RD versus those without RD, and it increases progressively, according to the degree of RD. These results could indicate the existence of a relationship between the evolution of the disease and premature aging of the retina (AU)

Retinal age as a predictive biomarker of the diabetic retinopathy grade.

OBJECTIVE: To apply artificial intelligence (AI) techniques, through deep learning algorithms, for the development and optimization of a system for predicting the age of a person based on a color retinography and to study a possible relationship between the evolution of retinopathy diabetes and premature ageing of the retina. METHODS: A convolutional network was trained to calculate the age of a person based on a retinography. Said training was carried out on a set of retinographies of patients with diabetes previously divided into three subsets (training, validation and test). The difference between the chronological age of the patient and the biological age of the retina was defined as the retinal age gap. RESULTS: A set of 98,400 images was used for the training phase, 1000 images for the validation phase and 13,544 for the test phase. The retinal gap of the patients without DR was 0.609 years and that of the patients with DR was 1905 years (p < 0.001), with the distribution by degree of DR being: mild DR: 1541 years, moderate DR: 3017 years, DR severe: 3117 years and proliferative DR: 8583 years. CONCLUSIONS: The retinal age gap shows a positive mean difference between diabetics with DR versus those without DR, and it increases progressively, according to the degree of DR. These results could indicate the existence of a relationship between the evolution of the disease and premature ageing of the retina.

Retinal Vessel Local Tortuosity under a Macula-to-Optic Disc Central-Framing Change.

Some ocular and cardiovascular diseases can be detected through the increased tortuosity of retinal blood vessels. Objective tortuosity measures can be obtained from digital image analysis of a retinography. This study tested a set of local tortuosity indices under a change in the frame center (macula, optic disc) of the eye fundus image. We illustrate the effects of such a change on 40 pairs of vessels evaluated with eight tortuosity indices. We show that the frame center change caused significant differences in the mean values of the vast majority of the tortuosity indices analyzed. The index defined as the ratio of the curvature to the arc length of a vessel segment proved to be the most robust in relation to a frame center change. Experimental results obtained from the analysis of clinical images are provided and discussed.

Neurocognitive Profile of the Post-COVID Condition in Adults in Catalonia-A Mixed Method Prospective Cohort and Nested Case-Control Study: Study Protocol.

The diagnosis of the post-COVID condition is usually achieved by excluding other diseases; however, cognitive changes are often found in the post-COVID disorder. Therefore, monitoring and treating the recovery from the post-COVID condition is necessary to establish biomarkers to guide the diagnosis of symptoms, including cognitive impairment. Our study employs a prospected cohort and nested case-control design with mixed methods, including statistical analyses, interviews, and focus groups. Our main aim is to identify biomarkers (functional and structural neural changes, inflammatory and immune status, vascular and vestibular signs and symptoms) easily applied in primary care to detect cognitive changes in post-COVID cases. The results will open up a new line of research to inform diagnostic and therapeutic decisions with special considerations for cognitive impairment in the post-COVID condition.

Validation of an autonomous artificial intelligence-based diagnostic system for holistic maculopathy screening in a routine occupational health checkup context.

PURPOSE: This study aims to evaluate the ability of an autonomous artificial intelligence (AI) system for detection of the most common central retinal pathologies in fundus photography. METHODS: Retrospective diagnostic test evaluation on a raw dataset of 5918 images (2839 individuals) evaluated with non-mydriatic cameras during routine occupational health checkups. Three camera models were employed: Optomed Aurora (field of view - FOV 50º, 88% of the dataset), ZEISS VISUSCOUT 100 (FOV 40º, 9%), and Optomed SmartScope M5 (FOV 40º, 3%). Image acquisition took 2 min per patient. Ground truth for each image of the dataset was determined by 2 masked retina specialists, and disagreements were resolved by a 3rd retina specialist. The specific pathologies considered for evaluation were "diabetic retinopathy" (DR), "Age-related macular degeneration" (AMD), "glaucomatous optic neuropathy" (GON), and "Nevus." Images with maculopathy signs that did not match the described taxonomy were classified as "Other." RESULTS: The combination of algorithms to detect any abnormalities had an area under the curve (AUC) of 0.963 with a sensitivity of 92.9% and a specificity of 86.8%. The algorithms individually obtained are as follows: AMD AUC 0.980 (sensitivity 93.8%; specificity 95.7%), DR AUC 0.950 (sensitivity 81.1%; specificity 94.8%), GON AUC 0.889 (sensitivity 53.6% specificity 95.7%), Nevus AUC 0.931 (sensitivity 86.7%; specificity 90.7%). CONCLUSION: Our holistic AI approach reaches high diagnostic accuracy at simultaneous detection of DR, AMD, and Nevus. The integration of pathology-specific algorithms permits higher sensitivities with minimal impact on its specificity. It also reduces the risk of missing incidental findings. Deep learning may facilitate wider screenings of eye diseases.

Functional Optical Coherence Tomography for Intrinsic Signal Optoretinography: Recent Developments and Deployment Challenges.

Intrinsic optical signal (IOS) imaging of the retina, also termed as optoretinogram or optoretinography (ORG), promises a non-invasive method for the objective assessment of retinal function. By providing the unparalleled capability to differentiate individual retinal layers, functional optical coherence tomography (OCT) has been actively investigated for intrinsic signal ORG measurements. However, clinical deployment of functional OCT for quantitative ORG is still challenging due to the lack of a standardized imaging protocol and the complication of IOS sources and mechanisms. This article aims to summarize recent developments of functional OCT for ORG measurement, OCT intensity- and phase-based IOS processing. Technical challenges and perspectives of quantitative IOS analysis and ORG interpretations are discussed.

Assessing the Utility and Patient Satisfaction of Virtual Retina Clinics During COVID-19 Pandemic.

PURPOSE: To explore whether the virtual retina clinic (VRC) has been a useful and safe platform for monitoring retinal diseases during the COVID-19 pandemic and assessing patient satisfaction. METHODS: A prospective observational study was conducted for patients with stable retinal diseases in Donostia University Hospital's Ophthalmology Service during the pandemic. All patients were assessed in the VRC with optical coherence tomography of the macula and widefield retinography, plus visual field tests in hydroxychloroquine retinopathy screenings. The VRC´s effectiveness was evaluated with repeat blind assessments and patient satisfaction with an adapted SERVQUAL scale. RESULTS: The most common diseases were diabetic retinopathy (30.3%) and age-related macular degeneration (21.8%). Most patients (74%) were eligible to continue in the VRC, 19.3% were referred to face-to-face (F2F) appointments and 6.6% were discharged. Patients underwent repeat blind assessments in F2F appointments to monitor VRC performance in 23.7% of the cases. The sensitivity to detect disease progression was 100%. The specificity was 80.1%. The VRC took half the time. The patient overall satisfaction rating was 9.8/10. CONCLUSION: The VRC, as an additional platform, supports F2F appointments. Almost three-quarters of patients could continue being safely seen in the VRC. The virtual approach decreases SARS-CoV-2 exposure. Patient satisfaction is very good. TRANSLATIONAL RELEVANCE: The VRC enables us to attend patients safely with decreased SARS-CoV-2 exposure.

Fractal evaluation in retinographies of individuals with different grades of diabetic retinopathy / Avaliação fractal de retinografias de indivíduos com diferentes graus de retinopatia diabética

ABSTRACT Purpose To evaluate the retinal blood vascular network of the retinographies of patients with different grades of diabetic retinopathy. Methods Ninety Retinographies (MESSIDOR database) were used, with different grades of diabetic retinopathy divided into 4 groups: no retinopathy (n=23), grade one (n=20), grade two (n=20) and grade three (n=27) diabetic retinopathy. The grades of diabetic retinopathy were classified according to the number of microaneurysms, number of hemorrhages and the presence of neovascularization. The images were skeletonized and quantified by fractal methods: dimension of box-counting (Dbc) and information (Dinf). Results The means of Dbc values of groups were around 1.25, without statistically significant difference in the dimension values between groups for whole retina. There was also no statistical difference in Dinf values between groups, whose means ranged between 1.294 ± 0.013 (group of grade 1) and 1.3 ± 0.017 (group of grade 3). The retinographies were divided into regions of equal areas. The fractal values of some retinal regions showed statistical differences, but these differences were not enough to show the sensitivity of fractal methods in identifying diabetic retinopathy. Conclusion The fractal methods were not able to identify the different grades of diabetic retinopathy in retinographies.

RESUMO Objetivo Avaliar a rede vascular sanguínea da retina a partir de retinografias de pacientes com diferentes graus de retinopatia diabética. Métodos Foram utilizadas 90 retinografias (banco de dados MESSIDOR), com diferentes graus de retinopatia diabética divididas em quatro grupos: sem retinopatia (n=23), retinopatia diabética de grau um (n=20), grau dois (n=20) e grau três (n=27). Os graus de retinopatia foram classificados conforme o número de microaneurismas, número de hemorragias e presença de neovascularização. As imagens foram esqueletizadas e quantificadas pelos métodos fractais: dimensão da contagem de caixas e informação. Resultados As médias dos valores das dimensões de contagem de caixas para todos os grupos foram próximas a 1,25, sem diferença estatisticamente significativa nos valores das dimensões entre os grupos para retina inteira. Também não houve diferença estatística nos valores da dimensão de informação entre os grupos, cujas médias variaram entre 1,294 ± 0,013 (grupo do grau 1) e 1,3 ± 0,017 (grupo do grau 3). As imagens retinianas foram divididas em regiões de áreas iguais. Os valores fractais de algumas regiões retinais mostraram diferenças estatísticas, mas estas não foram suficientes para mostrar a sensibilidade dos métodos fractais na identificação da retinopatia diabética. Conclusão Os métodos fractais não foram capazes de identificar os diferentes graus de retinopatia diabética em retinografias.

Diagnostic Accuracy and Detection Rate of Glaucoma Screening with Optic Disk Photos, Optical Coherence Tomography Images, and Telemedicine.

PURPOSE: The aim of this study was to evaluate the diagnostic accuracy of optical coherence tomography (OCT) and retinography in the detection of glaucoma through a telemedicine program. METHODS: A population-based sample of 4113 persons was randomly selected. The screening examination included a fundus photograph and OCT images. Images were evaluated on a deferred basis. All participants were then invited to a complete glaucoma examination, including gonioscopy, visual field, and dilated fundus examination. The detection rate, sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: We screened 1006 persons. Of these, 201 (19.9%) were classified as glaucoma suspects; 20.4% were identified only by retinographs, 11.9% only by OCT images, and 46.3% by both. On ophthalmic examination at the hospital (n = 481), confirmed glaucoma was found in 58 (12.1%), probable glaucoma in 76 (15.8%), and ocular hypertension in 10 (2.1%), and no evidence of glaucoma was found in 337 (70.0%). The detection rate for confirmed or probable glaucoma was 9.2%. Sensitivity ranged from 69.4% to 86.2% and specificity from 82.1% to 97.4%, depending on the definition applied. CONCLUSIONS: The combination of OCT images and fundus photographs yielded a detection rate of 9.2% in a population-based screening program with moderate sensitivity, high specificity, and predictive values of 84-96%.

Effects of Intravitreal Aflibercept on Retinal Function and Improvement of Macular Edema Associated With Diabetic Retinopathy.

Purpose: To determine the effectiveness of intravitreal aflibercept (IVA) on the retinal function in eyes with diabetic macular edema (DME). Methods: Twenty-five eyes of 25 patients with DME were treated with three consecutive monthly IVA injections. The retinal sensitivities (RS) within the central 10° were determined by microperimetry (MP). The central subfield macular thickness (CMT) was determined by optical coherence tomography, and the implicit times (IT) and amplitudes (Amp) of the flicker electroretinograms (ERGs) were determined from the ERGs elicited and recorded by the RETeval. The number of microaneurysms (MAs) was counted in the fundus photographs. The assessments were made before the IVA injections (pre-IVA) and one week after the IVA injections (post-IVA). The correlations between the reduction ratio of the MA numbers/CMT and RS/IT/Amp were evaluated. Results: The mean RS improved from 19.9 ± 5.9 dB to 22.0 ± 5.8dB, the CMT decreased from 485.7 ± 90.6 µm to 376.9 ± 81.6 µm, and the number of MAs decreased from 49.6 ± 33.2 to 24.8 ± 18.1 after the IVA injection (all P < 0.01). The changes in the IT from 31.3 ± 3.3 ms to 31.5 ± 3.1 ms and the Amp from 12.2 ± 5.5 µV to 11.3 ± 6.1µV post-IVA were not significant. A significant correlation was found between the relative changes in the CMT and RS (r = -0.43; P = 0.02), the MAs and RS (r = -0.38; P = 0.03). No significant correlation was observed between the relative changes of the number of MAs/CMT and IT/Amp. Conclusions: IVA can improve both central retinal function and anatomical conformation. Translational Relevance: A new aspect of aflibercept will be useful for DME treatment.

Achados de fundoscopia de pacientes diabéticos e/ou hipertensos / Fundoscopy findings of diabetic and/or hipertensive patients

Resumo Objetivo: Analisar a prevalência de alterações na fundoscopia de pacientes portadores de Diabetes Mellitus (DM) e/ou Hipertensão Arterial Sistêmica (HAS) encaminhados ao Serviço de Referência de Oftalmologia, localizado em uma Unidade Básica de Saúde do município de Patos, Paraíba (PB). Metodos: Estudo de caráter descritivo, transversal e com abordagem quantitativa, que envolveu um total de 22 pacientes. Para a coleta de dados, foi utilizado um questionário sobre a saúde ocular. Além disso, os integrantes da pesquisa participaram do teste da acuidade visual de Snellen e acuidade visual para perto, da medida da pressão intra-ocular e do exame da oftalmoscopia direta. Os que obtiveram pior acuidade visual foram conduzidos para a realização de retinografia. Os dados foram avaliados através de análises estatísticas utilizando o Statistical Package for the Social Sciences - SPSS. Resultados: Do total de 22 pacientes, 11 foram submetidos ao exame de retinografia. Destes, 36,3 % eram apenas diabéticos; 27,4% eram apenas hipertensos e 36,3% eram diabéticos e hipertensos. As principais alterações encontradas foram retinopatia diabética, retinopatia hipertensiva, catarata, glaucoma, nevus de coroide, retinose pigmentar e estafiloma peripapilar. Conclusão: Percebe-se que DM e HAS tem grande impacto negativo sobre a saúde ocular. Para diminuir esse efeito nocivo é necessário que o exame de fundo de olho seja realizado anualmente com a finalidade de diagnosticar precocemente certas patologias e evitar complicações futuras, culminando em menores custos para o sistema de saúde e mais qualidade de vida para os pacientes.

Abstract Objective: To analyze the prevalence of alterations in funduscopy of patients with Diabetes Mellitus (DM) and/or Systemic Arterial Hypertension (SAH) referred to the Ophthalmology Reference Service, located in a Basic Health Unit of the city of Patos, Paraíba). Methods: A descriptive, cross-sectional study with a quantitative approach, which involving a total of 22 patients. For data collection, a questionnaire on ocular health was used. In addition, the research members participated in the Snellen visual acuity test and visual acuity near, intraocular pressure measurement and direct ophthalmoscopy examination. Those who obtained worse visual acuity were conducted for retinography. The data were evaluated through statistical analysis using the Statistical Package for the Social Sciences - SPSS. Results: Of the total of 22 patients, 11 were submitted to retinography. Of these, 36.3% were diabetics only; 27.4% were hypertensive only and 36.3% were diabetic and hypertensive. The main alterations found were diabetic retinopathy, hypertensive retinopathy, cataract, glaucoma, choroidal nevus, pigmentary retinitis and peripapillary staphyloma. Conclusion: It is noticed that DM and SAH have a great negative impact on ocular health. To reduce this harmful effect it is necessary that the fundus eye exam be performed annually for the purpose of early diagnosis of certain pathologies and avoid future complications, culminating in lower costs for the health system and more quality of life for patients.

[Reliability of retinography for the detection of hypertensive retinopathy in Primary Care]. / Fiabilidad de la retinografía para la detección de retinopatía hipertensiva en Atención Primaria.

OBJECTIVE: High blood pressure is one of the most prevalent diseases in general adult population. Its importance lies in the complications it causes in target organs such as kidney, heart, brain and eye. The aim of this work is to evaluate the agreement in the evaluation and interpretation of retinographies of hypertensive patients by family doctors and ophthalmologists. MATERIAL AND METHODS: This is a multicentric cross-sectional study in which 976 hypertensive patients from 50 to 70 years old were involved. They were participants of the «Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study¼ (ISSYS project) carried out in primary care centers of Barcelona and who agreed to undergo retinography. Six family physicians and 2 ophthalmologists evaluated the presence of retinal lesions through the Keith-Wagener-Barker criteria. RESULTS: The inter/intra-observer Kappa concordance of the evaluations was analyzed. The evaluation of the retinographies under the usual conditions of clinical practice obtained a high subjective component with slight and fair intra-observer concordance values in the Keith-Wagener-Barker criteria. Only the assessment of the microaneurysms showed a moderate concordance and the ratio artery/vein was the worst concordant. CONCLUSIONS: The evaluation of the retinographies in habitual conditions of clinical practice has a high subjective component that is reflected in slight and fair inter-intraobserver concordance values. The use of objective reading systems in the assessment of retinography in hypertensive patients would be useful.

Quality and Feasibility of Automated Digital Retinal Imaging in the Emergency Department.

BACKGROUND: Emergency physicians (EPs) frequently evaluate patients at risk for sight-threatening conditions but may have difficulty performing direct ophthalmoscopy effectively. Digital fundus photography offers a potential alternative. OBJECTIVE: We sought to assess the performance of an automated digital retinal imaging platform in a real-world emergency department. METHODS: We performed a prospective, observational study of emergency department patients who were at risk for acute, nontraumatic, posterior segment pathology. Photographs were obtained using an automated digital retinal camera and were subsequently reviewed by an ophthalmologist. We recorded the number of attempts required, total time required, patient comfort, and findings on EP-performed direct ophthalmoscopy, if performed. RESULTS: Of 123 participants completing the study, 93 (75.6%) had ≥1 eye with a diagnostically useful image, while 29 (23.6%) had no photographs of diagnostic value. The mean number of attempts required to obtain images was 1.45 (range 1-3) and the mean elapsed time required to complete photography was 109.6 s. The mean patient comfort score was 4.6 on a 5-point scale, where 5 was the most comfortable. Direct ophthalmoscopy was performed by an emergency department provider for 19 (15.4%) patients. Acute findings were noted in 14 patients during expert review of fundus photographs, though in only 2 of these cases was direct ophthalmoscopy performed by an EP with only 1 finding ultimately identified correctly. CONCLUSIONS: Automated digital imaging of the ocular fundus is rapidly performed, is well tolerated by patients, and can be used to obtain diagnostic quality images without the use of pharmacologic pupillary dilation in most emergency department patients who are at risk for acute posterior segment pathology.

Non-Mydriatic Fundus Retinography in Screening for Diabetic Retinopathy: Agreement Between Family Physicians, General Ophthalmologists, and a Retinal Specialist.

PURPOSE: To determine the level of agreement between trained family physicians (FPs), general ophthalmologists (GOs), and a retinal specialist (RS) in the assessment of non-mydriatic fundus retinography in screening for diabetic retinopathy (DR) in the primary health-care setting. METHODS: 200 Diabetic patients were submitted to two-field non-mydriatic digital fundus camera. The images were examined by four trained FPs, two GOs, and one RS with regard to the diagnosis and severity of DR and the diagnosis of macular edema. The RS served as gold standard. Reliability and accuracy were determined with the kappa test and diagnostic measures. RESULTS: A total of 397 eyes of 200 patients were included. The mean age was 55.1 (±11.7) years, and 182 (91%) had type 2 diabetes. The mean levels of serum glucose and glycosylated hemoglobin A1c were 195.6 (±87.3) mg/dL and 8.9% (±2.1), respectively. DR was diagnosed in 166 eyes by the RS and in 114 and 182 eyes by GO1 and GO2, respectively. For severity, DR was graded as proliferative in 8 eyes by the RS vs. 15 and 9 eyes by GO1 and GO2, respectively. The agreement between the RS and the GOs was substantial for both DR diagnosis (GO1k = 0.65; GO2k = 0.74) and severity (GO1k = 0.60; GO2k = 0.71), and fair or moderate for macular edema (GO1k = 0.27; GO2k = 0.43). FP1, FP2, FP3, and FP4 diagnosed DR in 108, 119, 163, and 117 eyes, respectively. The agreement between the RS and the FPs with regard to DR diagnosis was substantial (FP2k = 0.69; FP3k = 0.73; FP4k = 0.71) or moderate (FP1k = 0.56). As for DR severity, the agreement between the FPs and the RS was substantial (FP2k = 0.66; FP3k = 069; FP4k = 0.64) or moderate (FP1k = 0.51). Agreement between the FPs and the RS with regard to macular edema was fair (FP1k = 0.33; FP2k = 0.39; FP3k = 0.37) or moderate (FP4k = 0.51). CONCLUSION: Non-mydriatic fundus retinography was shown to be useful in DR screening in the primary health-care setting. FPs made assessments with good levels of agreement with an RS. Non-mydriatic fundus retinography associated with appropriate general physicians training is essential for the DR screening.

Drusa de nervo ótico associada à estafiloma peripapilar congênito / Optic disk drusen associated with congenital peripapillary staphyloma

Resumo Nós descrevemos uma rara associação entre estafiloma peripapilar congênito e drusa de disco óptico em uma mulher de 47 anos de idade e visão normal.

Abstract We described a rare association between peripapillary staphyloma and optic disk drusen in a woman with 47 years old and normal vision.

Primeiros 5 anos de Implementação do Programa de Rastreio de Retinopatia Diabética no Centro Hospitalar do Porto / First 5 years of Implementation of Diabetic Screening Program in Centro Hospitalar do Porto

Resumo Objetivo: Caracterizar a população de diabéticos referenciados à consulta de Oftalmologia do Centro Hospitalar do Porto (CHP) através do programa de rastreio da ARS Norte, avaliar este tipo de método de rastreio e perceber o impacto do mesmo na dinâmica de um Serviço de Oftalmologia. Métodos: Avaliação retrospectiva dos processos clínicos dos utentes diabéticos referenciados à consulta de Rastreio de Retinopatia Diabética (RD) do CHP através do programa de rastreio da ARS Norte, entre Janeiro de 2012 e Dezembro de 2016. As variáveis analisadas foram: dados demográficos, duração e tipo de Diabetes Mellitus (DM), seguimento prévio em consulta de oftalmologia, tipo de retinopatia diabética e orientação subsequente. Resultados: Dos 613 doentes diabéticos observados nesta consulta 2.6% tinham DM tipo 1 e 97.4% tinham DM tipo 2, com duração média da doença de 15.8 anos e 6.6% não apresentava lesões de RD em qualquer um dos olhos; lesões de RD não proliferativa estavam presentes em 90.7% dos doentes, sendo bilaterais em 83.7% dos casos e 2.7% apresentava lesões de RD proliferativa em ambos os olhos. No momento da consulta, 31.9% apresentava maculopatia, em pelo menos um dos olhos. 51,1% dos doentes tinha no momento da consulta indicação para tratamento; 15.2% integraram a consulta de diabetes ocular do CHP por necessidade de vigilância e 33.7% tiveram alta para reintegrarem este programa de rastreio. Conclusões: O programa de rastreio de RD apresenta-se como uma ferramenta útil e necessária no diagnóstico precoce e tratamento atempado das lesões de RD.

Abstract Purpose: To characterize the population of diabetics referred to the Ophthalmology Department of the Centro Hospitalar do Porto (CHP) from the screening program of ARS Norte, to evaluate this type of screening method and to perceive the its impact in the dynamic of an Ophthalmology Department. Methods: Retrospective evaluation of the clinical processes of diabetic patients referred to the CHP Diabetic Retinopathy (DR) Screening Consultation from the ARS Norte screening program, between January 2012 and December 2016. The variables analyzed were demographic data, duration and type of Diabetes Mellitus (DM), previous follow-up in ophthalmology consultation, type of diabetic retinopathy and subsequent orientation. Results: Of the 613 diabetic patients observed in our Department referred from this program, 2.6% had type 1 DM and 97.4% had type 2 DM, with a mean illness duration of 15.8 years. 6.6% had no lesions of DR in any of the eyes. Non-proliferative DR lesions were present in 90.7% of the patients, being bilateral in 83.7% of the cases and 2.7% had proliferative DR lesions in both eyes. At the time of the consultation, 31.9% had maculopathy in at least 1 of the eyes. 51.1% of the patients had indication for treatment at the time of the referral. 15.2% were integrated in ocular diabetes section of CHP due to the need for surveillance and 33.7% were discharged to reintegrate this screening program. Conclusions: The DR screening program is a useful and necessary tool for the early diagnosis and early treatment of DR lesions.

Melanocitoma de la cabeza del nervio óptico en un adulto joven / Melanocytoma of the optic nerve head in a young adult

Se describe el caso clínico de un paciente de 34 años edad que en abril de 2012 asistió a la consulta de retina del Hospital General Docente "Dr. Juan Bruno Zayas" de Santiago de Cuba por presentar, desde hacía 3 meses aproximadamente, disminución progresiva de la visión en el ojo izquierdo. Los resultados de los exámenes oftalmológicos y complementarios efectuados confirmaron el diagnóstico de melanocitoma de la cabeza del nervio óptico

The case report of a 34 years patient that attended the retina service of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba in April, 2012 is described. He had for 3 months approximately, progressive vision decrease in the left eye. The results of the ophthalmologic and complementary tests confirmed the diagnosis of melanocytoma of the optic nerve head