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At least 433 records · Page 24Linked to original sources
PubMed1982

Ophthalmic technology for the clinician: direct ophthalmoscopy revisited.

The history and basic optical principles of the direct ophthalmoscope are reviewed, and new developments, including the halogen-tungsten bulb, are explored. To counter the problem of trying to discern retinal details through an immature cataract or an edematous cornea, a system has been designed that sends a thin light annulus along the outer edge of a dilated pupil, avoiding the middle of the cornea or lens. Recent studies suggest that the direct ophthalmoscope with a standard bulb at design voltage can safely be used steadily for only about a minute and a half, and occasional pausing during prolonged viewing is recommended.

Equipment Safety↗
PubMed2003

Vertical cup-to-disc ratio: agreement between direct ophthalmoscopic estimation, fundus biomicroscopic estimation, and scanning laser ophthalmoscopic measurement.

PURPOSE: Ophthalmoscopic estimation of the vertical cup-to-disc ratio (VCDR) of the optic nerve head is important in the management of patients with glaucoma or who are glaucoma suspects. The purpose of this study was to compare the accuracy of estimation of VCDR obtained with direct ophthalmoscopy with that obtained with fundus biomicroscopy through undilated pupils. Measurements of VCDR obtained with the Heidelberg Retina Tomograph (HRT), a confocal scanning laser ophthalmoscope, were used as a standard. METHODS: Thirty young, healthy adults had their optic discs photographed and then imaged and analyzed with the HRT. Due to HRT software limitations, the VCDR could not be calculated automatically, and so a validated VCDR measurement was derived. This was used as the standard against which ophthalmoscopic estimations were compared. Two months later, the subjects had their VCDRs estimated using direct ophthalmoscopy and fundus biomicroscopy performed in random order after varying time intervals. Agreement between ophthalmoscopic VCDR estimation and HRT-derived VCDR measurement was assessed by means of bias plots and the weighted kappa statistic. RESULTS: Compared with the HRT-derived VCDR measurement, both ophthalmoscopic techniques tended to underestimate VCDR. The bias with direct ophthalmoscopy was statistically significant. There were also wide variations in VCDR estimation with direct ophthalmoscopy and fundus biomicroscopy, which were more pronounced with direct ophthalmoscopy. The weighted kappa statistic indicated moderate agreement between fundus biomicroscopy and HRT-derived VCDR measurement. There was poor to fair agreement between direct ophthalmoscopy and HRT-derived VCDR measurement. The level of disagreement was independent of HRT-derived VCDR, optic nerve head size and pupil size for both direct ophthalmoscopy and fundus biomicroscopy. CONCLUSIONS: Fundus biomicroscopy enables more accurate, less variable VCDR estimation than direct ophthalmoscopy. The clinician should record which method they used to examine the optic nerve head so that subsequent clinical decisions are not influenced by apparent VCDR changes.

Adult↗
PubMed1998

Screening for diabetic retinopathy: the utility of nonmydriatic retinal photography in Egyptian adults.

Although regular screening for diabetic retinopathy with ophthalmoscopy or retinal photography is widely recommended in the United States and Europe, few reports of its use in developing countries are available. We compared the performance of screening by retinal photography with that of indirect ophthalmoscopy by using data from a population-based survey of diabetes and its complications in Egypt. During that project, 427 persons with diabetes underwent an eye examination and fundus photography with a non-mydriatic camera through a dilated pupil. Data from the examinations of the right eye of each patient are presented. Ninety-two (22%) of the 427 retinal photographs were ungradable; in 58 eyes (63%), this was due to media opacity (42 eyes with cataract, 3 with corneal opacity, and 13 with both). Agreement between retinal photography and indirect ophthalmoscopy was poor (kappa = 0.33; 95% CI = 0.27-0.39) and primarily due to the large number of eyes (n = 79) with ungradable photographs that could be graded by ophthalmoscopy. None of these eyes was judged by ophthalmoscopy to have sight-threatening retinopathy. Fifty-four photographs were diagnosed with greater retinopathy than found on ophthalmoscopy. Retinal photography with the nonmydriatic camera through a dilated pupil is a useful method to screen for diabetic retinopathy in most adults in Egypt. However, such screening strategies have limited use in older persons and in persons with corneal disease or cataract.

Adult↗
PubMed2006

Spectrum of foveal development in albinism detected with optical coherence tomography.

BACKGROUND: Optical coherence tomography (OCT) has shown the absence of a foveal depression in an individual with oculocutaneous albinism, type 1 (OCA1) and best-corrected visual acuity (BCVA) of 20/400. However, the presence of an annular light reflex in the macula has been noted with indirect ophthalmoscopy in other patients with albinism who have better vision. We studied macular architecture in albinism with OCT when binocular BCVA was > or = 20/60 and compared this to detection of foveal development with binocular indirect ophthalmoscopy. METHODS: Eleven patients with albinism and BCVA > or = 20/60 were recruited for OCT. Average central macular thickness was recorded. Presence of an oval annular reflex was determined with binocular indirect ophthalmoscopy. RESULTS: Mean binocular BCVA was 20/39 (range: 20/20 to 20/50). Twelve eyes had a rudimentary annular reflex detected with ophthalmoscopy. OCT was reliable in 20 of 22 eyes. A foveal depression was identified with OCT in four eyes. Mean macular thickness for these four eyes was 233 microm (+/- 22.5 microm). We found a weak inverse correlation between BCVA (logMAR) and thickness (r = -0.21). CONCLUSIONS: OCT shows the spectrum of foveal development in albinism, from complete absence of development to a central depression corresponding to a rudimentary annular reflex detected with ophthalmoscopy. The reduced rate of detection of foveal development with OCT compared with ophthalmoscopy is likely related to poor fixation in patients with nystagmus.

Adolescent↗
PubMedDate not supplied

A 'fail-safe' screening programme for diabetic retinopathy.

OBJECTIVE: To improve screening for diabetic retinopathy in a hospital diabetic clinic through the use of the audit process. DESIGN: Comparison of an existing system of screening for diabetic retinopathy (a specialist optometrist using ophthalmoscopy alone) with a new system in which a specialist optometrist examined retinal Polaroid photographs taken through pharmacologically dilated pupils and combined this with ophthalmoscopy in all cases except when the photographs were perfect and definitely showed no retinopathy. In this new system, the optometrist could discuss cases of uncertainty with a diabetes physician while the patient was still in the clinic with eyes dilated. SETTING: Inner city hospital diabetes clinic. SUBJECTS: 289 hospital diabetic clinic patients not already attending an ophthalmologist; a consecutive series of 144 such patients for the first audit, 145 for the repeat audit. MAIN OUTCOME MEASURES: Assessment of each screening system against a gold standard. For the first audit this was agreement by two of four diabetes physicians, who combined examination of the photographs with the findings from dilated ophthalmoscopy, on the classification of the retinae of each patient, guided by standard European criteria. For the second audit, the gold standard was enhanced by discussing the photographs and findings of all patients with an independent ophthalmologist. For patients requiring referral, a second ophthalmologist also commented on the case. RESULTS: The addition of retinal photography to universal pupil dilatation, and the availability of diabetes physician backup to discuss cases of uncertainty, greatly increased the optometrists' detection rate. Sensitivities for the first (ophthalmoscopy only) and second (ophthalmoscopy plus photography plus diabetologist back-up) audits were, respectively, 71.4% vs 100% for sight-threatening retinopathy, 33% vs 100% for retinopathy requiring six-month review, and 40.3% vs 97.2% for any retinopathy (p = 0.002). CONCLUSIONS: Optometrists specialising in diabetic retinopathy using Polaroid retinal photography and ophthalmoscopy, both through dilated pupils, backed up by experienced diabetologists to discuss cases of uncertainty, could form the basis of a retinopathy screening service that accurately identifies and categorises retinopathy and does not miss sight-threatening cases.

Diabetic Retinopathy↗
PubMed1999

The role of digital fundus photography in diabetic retinopathy screening. Digital Diabetic Screening Group (DDSG).

PURPOSE: The role of digital monochromatic nonmydriatic fundus photography as an adjunct in the diagnosis of diabetic retinopathy is evaluated. METHODS: 197 patients were sequentially evaluated by three different techniques: dilated ophthalmoscopy by an experienced ophthalmologist, performance of 7 standard color mydriatic stereo fields, and a single digital monochromatic nonmydriatic image incorporating the disc and macula. Stereo color photographs served as the reference standard and were compared to either ophthalmoscopy performed by a physician, or a single digital photograph transmitted electronically to a reading site and evaluated by a trained non-physician grader. Sensitivity and specificity of the three methods were compared. The decision as to whether or not to refer to an ophthalmologist for potential treatment (Kaiser modified ETDRS level > 21) was then chosen for analysis. RESULTS: A single nonmydriatic monochromatic digital photograph appeared equivalent to standard color photography and more sensitive than mydriatic ophthalmoscopy in the detection of diabetic retinopathy in this patient population. Sensitivity of digital photography compared with color photography was 78%, and the specificity 86% contrasted with comparable ratios of 34% and 100% for ophthalmoscopy versus color photography. No patient identified by ophthalmoscopy alone for referral based on retinopathy level of > 21 would have been missed by a single digital monochromatic photographic image. CONCLUSION: A single nonmydriatic monochromatic wide field digital photograph of the disc and macula in diabetic patients is a sensitive and cost-effective means for detecting diabetic retinopathy in high-risk populations.

Allied Health Personnel↗
PubMed1998

Non-mydriatic fundus photography: a viable alternative to fundoscopy for identification of diabetic retinopathy in an Aboriginal population in rural Western Australia?

PURPOSE: To evaluate the Canon CR5-45NM non-mydriatic fundus camera (Canon, Kanagawa, Japan) for identifying retinopathy and the need for laser treatment in a population of Aboriginal patients with diabetes mellitus in rural Western Australia. METHODS: Diabetic Aboriginal patients were photographed through undilated pupils using a Canon CR5-45NM non-mydriatic fundus camera, after which ophthalmoscopy was performed using indirect ophthalmoscopy through dilated pupils. The examining ophthalmologist recorded the presence of retinopathy and the need for laser treatment. A proportion of patients were rephotographed through dilated pupils. Photographs were reviewed by a second ophthalmologist who evaluated the quality of the image, the presence of retinopathy and the need for laser treatment. Results of fundus photographs and ophthalmoscopy were compared. RESULTS: Three hundred and twenty-eight eyes in 164 Aboriginal patients were examined. The mean patient age was 48.2 years (range 16-81 years) and the mean duration of diabetes was 7.5 years (range 1-35 years). Seventy-four eyes (22.6%) were diagnosed with retinopathy using combined examination techniques, 44 (59.5%) of which were identified by ophthalmoscopy and 55 (74.3%) by photography. Thirty-five eyes were deemed to need treatment, 18 (51.4%) of which were identified by ophthalmoscopy and 30 (85.7%) by photography. Kappa coefficient measurement for agreement for presence of retinopathy and need for referral was 0.41 and 0.53, respectively. Photograph quality was significantly improved following pupil dilation. CONCLUSIONS: The Canon CR5-45NM non-mydriatic fundus camera was relatively good at identifying diabetic retinopathy and could usefully be applied within a screening programme for treatable disease within this population.

Adolescent↗
PubMed2005

Agreement between stereoscopic photographs, clinical assessment, Heidelberg retina tomograph and digital stereoscopic optic disc camera in estimating vertical cup:disc ratio.

BACKGROUND: The purpose of the present study was to determine the agreement between stereo photography, Heidelberg retina tomograph (HRT), digital stereoscopic optic disc camera (DISCAM) and ophthalmoscopy in estimating the vertical cup : disc ratio (VCDR). METHODS: One hundred and ninety-nine eyes of 100 subjects from glaucoma clinics were examined by a single glaucoma specialist and the VCDR on ophthalmoscopy was recorded. All eyes were classified as definite glaucoma, glaucoma suspect or no glaucoma based on the entire clinical assessment. Two glaucoma specialists viewed stereo photographs of the eyes separately and independently. A trained technician acquired HRT and DISCAM images. The agreement of VCDR among the four modalities was assessed by the method described by Bland and Altman. RESULTS: Of the 199 eyes, 28.1% were classified as definite glaucoma, 36.2% as glaucoma suspect and 35.7% as no glaucoma. The 2 SD for the agreement between the two glaucoma specialists using stereo photographs was 0.18 VCDR. The 2 SD for the agreement between stereo photographs and HRT, DISCAM and ophthalmoscopy were 0.31, 0.31 and 0.28, respectively. The 2 SD for ophthalmoscopy and HRT was 0.32, for ophthalmoscopy and DISCAM it was 0.32, and for HRT and DISCAM it was 0.22. When the eyes were divided into tertiles according disc size and VCDR, the 2 SD was higher for smaller optic discs (<1.5 mm vertical height) and smaller optic cups (VCDR <0.4). CONCLUSIONS: There was good agreement between VCDR values estimated independently using stereo photographs by the two clinicians. However, when the different modalities were compared using Bland and Altman analysis, all showed poor agreement with a large 2 SD. The agreement was worse for small discs and smaller cups. The VCDR values obtained by the different methods were found not to be interchangeable in a clinic setting.

Adolescent↗
PubMed2006

RetCam imaging for retinopathy of prematurity screening.

PURPOSE: Indirect ophthalmoscopy is the gold standard for retinopathy of prematurity (ROP) screening. Screening for ROP with digital imaging has been proposed as a possible alternative. Our goal was to evaluate the longitudinal clinical outcomes of employing digital imaging to detect high-risk ROP. METHODS: Serial RetCam imaging and indirect ophthalmoscopy were performed on 43 premature infants. A masked reader evaluated the images and made management recommendations that were compared with indirect ophthalmoscopy results. Successful screening was determined by correctly identifying progression to prethreshold or threshold disease with referral for indirect ophthalmoscopy. Unsuccessful screening was determined by failure to identify prethreshold or threshold disease, inaccurately detecting prethreshold or threshold disease, or inability to evaluate for ROP. RESULTS: No cases of prethreshold or threshold disease were missed by the reader. The reader overestimated prethreshold or threshold disease in 5% of cases. Initial screening in 21% of cases could not be evaluated for ROP secondary to poor image quality. Digital photography had a sensitivity of 100% and specificity of 97.5% in detecting prethreshold and threshold ROP. Positive-predictive value of digital photography was 67% and negative-predictive value was 100%. CONCLUSIONS: Screening and management of ROP using RetCam imaging did not fail to detect prethreshold or threshold disease when images could be obtained. Ophthalmologic examinations were needed in 20% of cases that did not reach threshold or prethreshold disease because of poor image quality or overestimation of ROP. RetCam screening may safely reduce the overall number of indirect ophthalmologic examinations required.

False Positive Reactions↗
PubMed2002

Scanning laser ophthalmoscope findings in acute macular neuroretinopathy.

PURPOSE: The typical reddish-brown retinal lesions of acute macular neuroretinopathy are difficult to detect. We demonstrate a role for scanning laser ophthalmoscopy in the diagnosis of acute macular neuroretinopathy. METHODS: Observational case report. We used scanning laser ophthalmoscopy in a 23-year-old woman with acute macular neuroretinopathy. RESULTS: In contrast to biomicroscopy, color fundus photography, and red-free fundus photography, scanning laser ophthalmoscopy precisely disclosed the size of the lesions within the macula. Microperimetry showed absolute scotomata corresponding to the macular lesions. CONCLUSION: Scanning laser ophthalmoscopy enhances the visibility of the retinal lesions in acute macular neuroretinopathy. The lesion size can be determined more precisely, and follow-up of patients is more accurate compared with conventional techniques.

Acute Disease↗