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Biomedical subjects

K Yogesan

Publications and source records attributed to K Yogesan.

At least 19 recordsLinked to original sources
PubMed2005

Emergency eye care in rural Australia: role of internet.

PURPOSE: Significant differences exist in the utilization of emergency eye care services in rural and urban Australia. Meanwhile, influence of internet-based technology in emergency eye care service utilization has not been established. This study aims to demonstrate, from a health provider perspective, an internet-based service's impact on emergency eye care in rural Australia. METHODS: The teleophthalmology service was initiated in the Carnarvon Regional Hospital (CRH) of the Gascoyne region in Western Australia. A digital, slit lamp and fundus camera were used for the service. Economic data was gathered from the Department of Health of Western Australia (DOHWA), the CRH and the Lions Eye Institute. RESULTS: During the study period (January-December, 2003) 118 persons took part in teleophthalmology consultations. Emergency cases constituted 3% of these consultations. Previous year, there were seven eye-related emergency evacuations (inter-hospital air transfers) from the Gascoyne region to City of Perth. CONCLUSIONS: Analysis demonstrates implementation of internet-based health services has a marked impact on rural emergency eye care delivery. Internet is well suited to ophthalmology for the diagnosis and management of acute conditions in remote areas. Integration of such services to mainstream health care is recommended.

Adolescent↗
PubMed2001

Online eye care in prisons in Western Australia.

In prisons, prison medical officers provide general medical care. However, if specialist care is needed then the prisoner is transported to a specialist medical centre. This is a costly procedure and prison escapes occur during transportation. We have tested our Internet-based eye care system in prisons in Western Australia. Medical and ophthalmic history, visual acuity and intraocular pressure were stored in a browser-based multimedia database. Digital images of the retina and the external eye were recorded and transmitted to a central server. Based on the medical data and the digital images, the specialist ophthalmologist could provide a diagnosis within 24 h. Eleven patients (mean age 48, range 30-82 years) were reviewed during two separate visits to a maximum-security prison in Western Australia. Our main aim was to train prison medical officers and nurses to operate the portable ophthalmic imaging instruments and to use the Internet-based eye care system. The outcome of the pilot study indicated that considerable savings could be made in transport costs and the security risk could be reduced. The Ministry of Justice in Western Australia has decided to implement telemedicine services to provide regular ophthalmic consultation to its prisons.

Adult↗
PubMed2000

Continued progression of retinopathy despite spontaneous recovery to normoglycemia in a long-term study of streptozotocin-induced diabetes in rats.

BACKGROUND: This long-term (2.3 years) study determines the temporal relationship between systemic glucose levels and the progression of diabetic retinopathy during the natural course of streptozotocin-induced diabetes in rats. METHODS: Of 367 rats, 200 were randomly assigned into a group injected with streptozotocin (50 mg.kg(-1)) and 167 into a control group. Subsets of the rats were killed at 6, 28, 40, 65, 90 and >100 weeks post induction to allow the severity of retinopathy to be assessed quantitatively and qualitatively by trypsin digests of the retinal vasculature. Concurrently blood glucose, body weight and death rate were monitored. RESULTS: Three glycemic phases were observed in the streptozotocin rats. In phase 1 (0 to 36-40 weeks) hyperglycemia was established and maintained. In phase 2 (36-40 to 84-90 weeks) normoglycemia was restored, and maintained during phase 3 (84-90 to 120 weeks). Control rats were normoglycemic throughout. The retinal microangiopathy was marked at 28 weeks during phase 1, developed more slowly in phase 2 and continued to worsen with loss of capillaries in all retinas and saccular microaneurysms present in 50% of retinas in phase 3. Cumulative death rate in streptozotocin rats also followed three phases, with maximum vulnerability occurring between 28 and 40 weeks. Body weight was significantly lower in streptozotocin rats throughout, increasing slowly in phase 1, then more rapidly during and after spontaneous glycemic recovery. CONCLUSION: The worsening retinopathy, despite sustained recovery to normoglycemia, implies that good glucose control alone does not stop the progression of the retinal microangiopathy at this late stage.

Animals↗
PubMed2000

Neuroretinal rim measurement error using PC-based stereo software.

The neuroretinal rims of a set of glaucoma patients were measured using digitized stereo photographs, to determine the reproducibility of computerized stereo measurements of the neuroretinal rim. Each rim was measured five times at 18 locations, with measurement error (ME) defined as the mean of standard deviations of each set of measurements. The following ME were determined: (i) inter-sessional variability (n = 27 right and 24 left eyes, at t1 and t2); (ii) inter-assessor variability (n = 9, 2 assessors); and (iii) variability after colour adjustment algorithms were applied (n = 15). The results were as follows: (i) inter-sessional variability was 3.41+/-1.08 for t1 and 3.22+/-0.84 for t2; (ii) there was a significant difference between the two assessors, although the ME was still low; and (iii) there was no significant differences between the ME of unadjusted and adjusted images. With a measurement error of up to 11% of rim width, these results show that lowcost rim measurements can be made using PC-based software.

Algorithms↗
PubMed2000

Fred Hollows lecture: digital screening for eye disease.

The purpose of this study was to explore progress, in the adaptation to community screening for blinding eye disease, of digital imaging devices and technology for storage and transmission. Available imaging systems were compared to gold standard clinical photography in terms of sensitivity and specificity for diagnosis of common blinding eye conditions. Since the use of expensive non-portable imaging devices is likely to be limited for widespread community screening purposes, a portable fundus camera (Nidek, Chiyoda-ku, Japan) and a prototype monocular digital indirect ophthalmoscope constructed at the Lions Eye Institute (LEI) were selected for comparative trials for the screening of optic disc cupping, glaucoma and clinical signs of diabetic retinopathy. Fifty-one eyes of 27 consecutive patients being assessed at the LEI clinic for glaucoma were dilated and photographed with a Zeiss retinal camera, and digital images were taken with the portable Nidek NM100 fundus camera (Carl Zeiss, Oberkochen, Germany) or with a prototype digital monocular indirect ophthalmoscope. Vertical cup: disc ratios (VCDR) were measured on the disc photographs by one ophthalmologist while three other clinicians were presented with compressed digital images in random order to estimate VCDR. Field trials were also carried out to demonstrate the practicality of compression, local storage and then transmission by mobile telephone ISDN lines and satellite, of optic discs and fundus images of patients with diabetes in either rural Western Australia or Surabaya, Indonesia. Kappa values of correlations of measurement of agreement between measured and estimated VCDR were 0.87, 0.45 and 0.84, respectively, for the three observers, corresponding to a specificity of 79-97% and a sensitivity of 70-95%. The portable Nidek fundus camera was also assessed for specificity and sensitivity in the diagnosis of diabetic retinopathy in comparison to standard Zeiss fundus camera photographs. Of 49 eyes in 25 consecutive patients attending the LEI clinic for assessment of diabetic retinopathy, three ophthalmologists assessed photographs and images in random order. When used for screening diabetic retinopathy, the digital images of the Nidek camera were graded as adequate quality in only 56% of eyes compared to 93% of the photographs. The kappa value of agreement in analysis of diabetic retinopathy was only 0.30. The prototype digital monocular indirect ophthalmoscope compared favourably with the Nidek camera. At 1:5 compression, images of size 36 kB transmitted from Surabaya to Perth took 29 s on the mobile telephone, while uncompressed images took 170 s. Images compressed 1:5 were transmitted in 60 s using the satellite telephone, while the uncompressed images took 240 s. Satellite transmission was more expensive but the lines were more stable than telephone connections from Indonesia. Digital imaging is becoming a powerful tool for ophthalmology in clinical records, teaching and research, and interoffice diagnostic opinions. It also has enormous potential for community screening for blinding eye diseases, such as glaucoma and diabetic retinopathy. Inexpensive portable imaging devices that are easy to use, and on which local health workers might be trained, must be developed and validated in terms of sensitivity and specificity of performance. The technology of image capture, image compression, transmission, data base storage and analysis is rapidly evolving and becoming less expensive.

Diabetic Retinopathy↗
PubMed2000

Telemedicine screening of diabetic retinopathy using a hand-held fundus camera.

The objective was to evaluate digital images of the retina from a handheld fundus camera (Nidek NM-100) for suitability in telemedicine screening of diabetic retinopathy. A handheld fundus camera (Nidek) and a standard fundus camera (Zeiss) were used to photograph 49 eyes from 25 consecutive patients attending our diabetic clinic. One patient had cataracts, making it impossible to get a quality image of one of the eyes (retina). The Nidek images were digitized, compressed, and stored in a Fujix DF-10M digitizer supplied with the camera. The digital images and the photographs were presented separately in a random order to three ophthalmologists. The quality of the images was ranked as good, acceptable or unacceptable for diabetic retinopathy diagnosis. The images were also evaluated for the presence of microaneurysms, blot hemorrhages, exudates, fibrous tissue, previous photocoagulation, and new vessel formation. kappa Values were computed for agreement between the photographs and digital images. Overall agreement between the photographs and digital images was poor (kappa < 0.30). On average, only 24% of the digital images were graded as being good quality and 56% as having an acceptable quality. However, 93% of the photographs were graded as good-quality images for diagnosis. The results indicate that the digital images from the handheld fundus camera may not be suitable for diagnosis of diabetic retinopathy. The images shown on the liquid crystal display (LCD) screen of the camera were of good quality. However, the images produced by the digitizer (Fujix DF-10M) attached to the camera were not as good as the images shown on the LCD screen. A better digitizing system may produce better quality images from the Nidek camera.

Diabetic Retinopathy↗
PubMed2000

International transmission of tele-ophthalmology images.

Tele-ophthalmic consultations were conducted between a hospital in East Java, Indonesia, and an ophthalmology centre in Perth, Western Australia. Twenty-two eyes of 14 subjects were screened for glaucoma using a hand-held fundus camera. Optic disc images comprised 267 x 234 pixels at 24 bit/pixel (187 kByte). The images were compressed and stored together with patient information on a laptop computer. The images were then transmitted to Perth using either a mobile phone or a satellite phone, taking 170 s or 240 s, respectively. Images were also compressed to five different compression levels before transmission. At a compression ratio of 1:5, the images were 36 kByte in size and took 29 s to transmit by mobile phone and 60 s by satellite phone. To measure the loss of quality, the root mean square error was calculated for each colour component, comparing the transmitted and original images. The coefficients of variation were 10% (green), 15% (blue) and 22% (red). The images received in Perth were considered to be of excellent quality and readily interpreted by ophthalmologists in terms of the likely presence of glaucoma.

Glaucoma↗
PubMed2000

Tele-ophthalmology screening for retinal and anterior segment diseases.

A digital indirect ophthalmoscope (DIO) was developed and tested for use in tele-ophthalmology screening for posterior and anterior segment diseases. Using custom software, images from the DIO were digitized, compressed, stored and transmitted to a centralized eye clinic for interpretation. A total of 43 subjects were primarily screened for glaucoma using the DIO, a hand-held fundus camera and a stereo fundus camera. The photographic slides from the stereo fundus camera used as gold standards. Images (390 x 300 pixels x 3 bits) were stored using a laptop computer together with patient information. Image quality received at the central eye clinic was good and showed adequate diagnostic information. An ophthalmologist estimated cup-disc ratios and graded the quality of the images. The sensitivity and specificity of each instrument was calculated. A high sensitivity and specificity was found when using the DIO, indicating that it could be used in tele-ophthalmic screenings. Further modifications are needed to make the instrument more user-friendly and to enable it to be used with undilated pupils, so that it can be easily operated by health-care personnel in remote areas. The camera can also be used to image gross external eye pathology.

Anterior Eye Segment↗
PubMed2000

Methods and limits of digital image compression of retinal images for telemedicine.

PURPOSE: To investigate image compression of digital retinal images and the effect of various levels of compression on the quality of the images. METHODS: JPEG (Joint Photographic Experts Group) and Wavelet image compression techniques were applied in five different levels to 11 eyes with subtle retinal abnormalities and to 4 normal eyes. Image quality was assessed by four different methods: calculation of the root mean square (RMS) error between the original and compressed image, determining the level of arteriole branching, identification of retinal abnormalities by experienced observers, and a subjective assessment of overall image quality. To verify the techniques used and findings, a second set of retinal images was assessed by calculation of RMS error and overall image quality. RESULTS: Plots and tabulations of the data as a function of the final image size showed that when the original image size of 1.5 MB was reduced to 29 KB using JPEG compression, there was no serious degradation in quality. The smallest Wavelet compressed images in this study (15 KB) were generally still of acceptable quality. CONCLUSIONS: For situations where digital image transmission time and costs should be minimized, Wavelet image compression to 15 KB is recommended, although there is a slight cost of computational time. Where computational time should be minimized, and to remain compatible with other imaging systems, the use of JPEG compression to 29 KB is an excellent alternative.

Humans↗
PubMed1999

A case for electronic manipulation of medical images?

Two ophthalmic case histories requiring differing techniques to document the long-term outcomes of ocular tumours are presented. In the first case, after documenting a treated choroidal melanoma it was necessary to intervene with digital manipulation to enhance the images for clinical interpretation. Conversely, after documenting an iris tumour over an eight-year period, it was considered that the original images were suitable for interpretation without intervention. This raises the issue of images presented as legal evidence when digital technology is used to manipulate and enhance the images. Are these images admissible as evidence in court, and should the original data also be archived to prevent conflicting interpretations by the legal system? In light of The House of Lords recommendations on digital images as evidence, it is suggested that both the manipulated and original images are archived to avoid debate on the extent to which an image has been altered.

Choroid Neoplasms↗
PubMed1999

Evaluation of a portable fundus camera for use in the teleophthalmologic diagnosis of glaucoma.

PURPOSE: The digital images of the optic disk from a portable fundus camera were evaluated for suitability in teleophthalmologic screening for glaucoma. METHODS: Fifty-one eyes of 27 consecutive patients from our glaucoma clinic were dilated and photographed with a Zeiss FF retinal camera (Carl Zeiss, Oberkochen, Germany) and a portable Nidek NM-100 (Nidek, Tokyo, Japan) fundus camera. Digital images from the portable fundus camera were digitized, compressed and stored in a Fujix DF-10M (Fuji, Tokyo, Japan) digitizer. Lossy compressed digital images and photographs from the Zeiss camera were presented separately in random order to three ophthalmologists for estimation of vertical cup:disk ratios (VCDR) and to evaluate image quality as good, acceptable, or unacceptable for screening glaucoma. Gold standard VCDRs were measured from monoscopic photographic slides obtained using the Zeiss camera by a fourth ophthalmologist. RESULTS: Measurement of agreement (Kappa values) between estimated VCDR of digital images and photographs by the three ophthalmologists were 0.52, 0.38, and 0.50 respectively. Agreement between gold standard and estimated VCDR from photographs were 0.87, 0.45, and 0.84 respectively (specificity between 79% and 97%, sensitivity between 70% and 95%). Kappa values obtained between gold standard and estimated VCDR from digital images were 0.52, 0.49, and 0.49, respectively (specificity between 68% and 79%, sensitivity between 67% and 87%. CONCLUSION: Moderate to good agreement indicates that the digital images from the portable fundus camera may be suitable for optic disk assessment in the current configuration. This easy to use Nidek hand-held camera could be a viable instrument for teleophthalmology if a better digitizing system is incorporated to improve the quality of the images.

Diagnostic Techniques, Ophthalmological↗
PubMed1998

A personal computer-based method of stereo chronometry for measuring neuroretinal rim width: a pilot study.

PURPOSE: Quantifying neuroretinal rim width from optic disc photographs to study glaucomatous progression requires precise, reproducible measurements. We explored the use of a personal computer with three-dimensional capabilities to enhance measurement accuracy and repeatability. METHODS: A simultaneous stereo retinal camera was used to serially photograph the optic discs often glaucomatous eyes with a mean interval of 18 months. The neuroretinal rims were qualitatively assessed as either stable (five) or narrowing (five). The images were measured using software written for an IBM compatible personal computer The measurements were compared from the earliest to the most recent image and the five narrowed rims were correctly identified. RESULTS: This simple, low-cost method allowed both three-dimensional viewing and measurement of the optic disc rim from simultaneous stereo images. CONCLUSIONS: This method is, potentially, more sensitive in identifying glaucomatous rim changes than conventional, subjective image comparison techniques.

Glaucoma↗
PubMed1998

Tele-ophthalmic screening using digital imaging devices.

BACKGROUND: Digital imaging systems provide immediate, magnified images that can easily be analysed, enhanced, archived, printed on near photographic-quality paper and transferred electronically to remote computers. We have assembled a digital ophthalmic system and tested it on patients with some common causes of blindness: corneal scarring and cataract, diabetic retinopathy, macular degeneration and glaucoma. METHODS: Digital images were obtained using a variety of ophthalmic imaging devices ranging from slit-lamp, fundus camera, indirect ophthalmoscope and scanning laser ophthalmoscope. These images were compressed in order to concentrate image information (image size reduced by 90-95%) and minimize transmission time (reduced by 97-98%). Standard or mobile telephone lines were used to transmit images to remote terminals. RESULTS/DISCUSSION: Transmission time was reduced from 15-20min to 20-30s and the image size was reduced from 1.3 MB to 20-30 kB by compressing the images before transmission. Image quality is still excellent.

Cataract↗
PubMed1998

Digital image analysis of hematopoietic colonies in vitro.

A system for automatic analysis of in vitro hematopoietic colonies is described and evaluated. With the standard resolution provided by video cameras, the improvement in visualization obtained using features other than size and darkness when classifying potential colonies appears to be limited. We confirmed this by comparing results obtained with the test system with those obtained with a commercial one. However, for some applications it may be useful to supplement the system with specific methods, e.g., to separate merged colonies. Digital image analyses provide new possibilities, for instance of measuring the total cellularity of the dish or analyzing colonies according to the size and cell density of each colony. Examples provided are time course studies of colony development, cellularity feedback effects on colony sizes, and bell-shaped dose-response curves for the growth stimulation obtained by certain conditioned media on a subpopulation of progenitor cells that gives rise to large colonies.

Animals↗
PubMed1996

Entropy-based texture analysis of chromatin structure in advanced prostate cancer.

A new texture operator, gray-level entropy matrix (GLEM), was developed, and nine new textural features were extracted from this matrix. These textural features were applied to light microscopy images of nuclei taken from monolayers of advanced prostate cancer cells representing two different prognostic groups: hormone-sensitive (good prognosis) and hormone-resistant (poor prognosis) tumors. A comparison between the classification results obtained from GLEM features and those obtained from standard textural estimators is also discussed. Single features that gave correct classification rates better than 65% were included in a discriminant analysis in order to find the optimal set of features to discriminate between the two prognostic groups in the training data set. The best combination of features includes three GLEM features together with ENTROPY extracted from gray-level cooccurrence matrix, and this combination gave a correct classification rate of 95% using the leaving-one-out technique. The influences of image sharpness and number of cells were also investigated. The features based on entropy or degree of scatter of minute structures can be used to discriminate between hormone-sensitive and hormone-resistant prostate carcinomas.

Cell Nucleus↗
PubMed1996

Nuclear texture analysis: a new prognostic tool in metastatic prostate cancer.

This report describes the prognostic value of computerized nuclear texture analysis in metastatic prostate cancer. Seventy-seven patients with histologically verified prostate carcinomas and skeletal metastases were selected from a Scandinavian multicenter study (SPCG-2). Thirty-six therapy-resistant patients experienced objective progression and cancer-related death within 2 years after orchiectomy. Thirty patients responded well to orchiectomy, i.e., showed objective disease remission and no signs of progression during 3 years of follow-up. From this data set, 10 randomly chosen therapy-resistant and 10 randomly chosen therapy-sensitive carcinomas were used in our previous study to find the optimal combination of features that can discriminate between the two groups (Yogesan et al.: Cytometry 24:268-276, 1996). In addition to these two groups, 11 patients experienced stable disease or disease remission during the first year and a secondary progression during the second or third year of follow-up, with subsequent cancer-related death. Traditional clinical prognostic factors such as histopathological grading and serum markers could not discriminate between these groups of patients. Therefore, image analysis techniques based on texture analysis have been utilized in this study of prognosis of prostate cancer. Feulgen-stained monolayers of nuclei were prepared from paraffin-embedded material taken from the primary tumor before endocrine ablation. Four different textural features were selected from the training data set to calculate the discriminating function. This function separated the therapy-sensitive and the therapy-resistant patients with 87% accuracy in the independent data set. This study demonstrates that it is possible to predict tumor progression and survival for endocrine-ablated metastatic prostate carcinomas using computerized nuclear texture analysis on light microscopy images from prostate biopsies taken at the time of diagnosis.

Aged↗