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Circumferential profiles of peripapillary surface height with confocal scanning laser ophthalmoscopy.

The purpose of this study was to compare the circumferential profiles of relative peripapillary retinal surface height (RPSH) between normal and glaucoma, with a confocal scanning laser ophthalmology (CSLO), and to examine the ability of the mean height to distinguish glaucoma from normal. Fifty-three patients with open-angle glaucoma and forty-three normal subjects matched for age, race and refractive error were studied. To extract circumferential profiles, we developed software to quantify RPSH from images obtained with a CSLO (Heidelberg Retina Tomograph (HRT), Heidelberg Engineering, Germany, Software: IR1-V1.11) outside the optic disc margin every 50 microns. Mean heights from circumferential profiles were calculated and compared between normal and glaucoma. Receiver operating characteristic (ROC) curves were used to evaluate sensitivity and specificity of the mean height to discriminate normal from glaucoma subjects. T he average (+/- SD) visual field mean deviation in the glaucoma group was -4.8 +/- 3.4dB. The average height of each circumference increased from the disc margin to 250 microns away in both normal and glaucoma subjects. There were statistically significant differences for the mean height (P < 0.001) between the two groups. The largest difference between normal and glaucoma was found in the inferior sector compared with the other sectors (p < 0.001). The sensitivity, specificity and diagnostic precision of the mean height were 83%, 67% and 76%, respectively. The mean height from the circumferential profiles of RPSH can be used as a useful marker to identify early glaucoma.

Exfoliation Syndrome↗

Artificial tear gel as a gonioscopic and contact lens ophthalmoscopy fluid.

An easy and convenient method of using a commercially available clear lubricant eye gel for diagnostic and therapeutic contact lens applications at the slit lamp is described. The authors used hydroxypropyl methylcellulose 0.3% as a medium for contact lens applications and compared it to the traditional hydroxypropyl methylcellulose 2.5%. Hydroxypropyl methylcellulose 0.3% as a contact lens solution is clear, viscous, and easy to apply; does not require irrigation after use; and has levels of convenience, safety, and visual recovery superior to the standard 2.5% solution characteristics. The 0.3% gel could be used as an effective and convenient gonioscopic and ophthalmoscopic contact medium.

Contact Lenses↗

Screening for retinopathy of prematurity--a comparison between binocular indirect ophthalmoscopy and RetCam 120.

AIM: To compare the photographic screening for retinopathy of prematurity (ROP) using RetCam 120 with binocular indirect ophthalmoscope (BIO), which is the current gold standard. SETTING AND DESIGN: Prospective, comparative study. MATERIALS AND METHODS: A total of 87 RetCam examinations were performed on 27 premature babies. They were stored in a separate file after deleting the identifying information. At the same visit using the BIO with scleral depression, an experienced vitreoretinal surgeon evaluated the fundus in detail. A masked examiner then evaluated the RetCam photographs for presence or absence of ROP, the stage and zone of the disease and the presence or absence of plus disease. These data were then compared with the BIO findings to determine the sensitivity, specificity and the positive and negative predictive values of the method. RESULTS: ROP was detected in 63 of 87 examinations by BIO and in 56 of 87 RetCam examinations. Nine RetCam examinations were false-negative and two were false-positive. Sensitivity of RetCam was 85.71% (54/63) and specificity was 91.66% (22/24). The positive and negative predictive values were 96.43% and 70.97% respectively. CONCLUSION: Nine cases having ROP were missed by the RetCam. All these cases were either in zone 3 or the outer part of zone 2, which later regressed. These were missed mostly because of the restricted mobility of the camera head caused by its size and the barrier caused by the lid speculum arms. No case of threshold ROP was missed. RetCam may replace BIO for screening of ROP.

Diagnosis, Differential↗

[Ophthalmoscopy].

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Contraindications↗

Comparing neural networks and linear discriminant functions for glaucoma detection using confocal scanning laser ophthalmoscopy of the optic disc.

PURPOSE: To determine whether neural network techniques can improve differentiation between glaucomatous and nonglaucomatous eyes, using the optic disc topography parameters of the Heidelberg Retina Tomograph (HRT; Heidelberg Engineering, Heidelberg, Germany). METHODS: With the HRT, one eye was imaged from each of 108 patients with glaucoma (defined as having repeatable visual field defects with standard automated perimetry) and 189 subjects without glaucoma (no visual field defects with healthy-appearing optic disc and retinal nerve fiber layer on clinical examination) and the optic nerve topography was defined by 17 global and 66 regional HRT parameters. With all the HRT parameters used as input, receiver operating characteristic (ROC) curves were generated for the classification of eyes, by three neural network techniques: linear and Gaussian support vector machines (SVM linear and SVM Gaussian, respectively) and a multilayer perceptron (MLP), as well as four previously proposed linear discriminant functions (LDFs) and one LDF developed on the current data with all HRT parameters used as input. RESULTS: The areas under the ROC curves for SVM linear and SVM Gaussian were 0.938 and 0.945, respectively; for MLP, 0.941; for the current LDF, 0.906; and for the best previously proposed LDF, 0.890. With the use of forward selection and backward elimination optimization techniques, the areas under the ROC curves for SVM Gaussian and the current LDF were increased to approximately 0.96. CONCLUSIONS: Trained neural networks, with global and regional HRT parameters used as input, improve on previously proposed HRT parameter-based LDFs for discriminating between glaucomatous and nonglaucomatous eyes. The performance of both neural networks and LDFs can be improved with optimization of the features in the input. Neural network analyses show promise for increasing diagnostic accuracy of tests for glaucoma.

Discriminant Analysis↗

[Benefit of scanning laser ophthalmoscopy for detecting retinal nerve fiber layer defects in patients with intraocular hypertension].

PURPOSE: To compare the ability to identify RNFL alterations between standard images and SLO images in a group of patients suffering from ocular hypertension. METHODS: We evaluated RNFL in sixty patients with ocular hypertension and with normal perimetry, by using standard photography and SLO. Two different independent observers evaluated the images on two different ocassions. RESULTS: We studied 118 eyes, twelve eyes were rejected because of the low quality of the images. Four cases of diffuse atrophy and five patients with wedge shaped defects were observed using both methods. Statistical analysis showed no differences between both exploration techniques or between observers. CONCLUSIONS: RNFL study with SLO seems to be at least as reliable as standard photography as a method to evaluate RNFL defects. SLO has also proved to be much easier, and faster than traditional methods.

Female↗