1
|
Kalloniatis M, Wang H, Phu J, Tong J, Armitage J. Optical coherence tomography angiography in the diagnosis of ocular disease. Clin Exp Optom 2024:1-17. [PMID: 38452795 DOI: 10.1080/08164622.2024.2323603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
Clinical imaging provided by optical coherence tomography (OCT) and its variant, OCT-angiography (OCT-A), has revolutionised eyecare practice. The imaging techniques allow for the identification and quantification of ocular structures, supporting the diagnosis and prognosis of eye disease. In this review, an overview of the usefulness of OCT-A imaging in the diagnosis and management of a range of ocular conditions is provided when used in isolation or in combination with other imaging modalities and measures of visual function (visual field results). OCT-A imaging has the capacity to identify and quantify ocular vasculature non-invasively, thereby assisting the clinician in the diagnosis or to determine the efficacy of intervention in ocular conditions impacting retinal vasculature. Thus, additional clinically useful information can be obtained in eye diseases involving conditions such as those impacting retinal vessel occlusion, in diabetic retinopathy, inherited retinal dystrophy, age-related macular degeneration, choroidal neovascularisation and optic nerve disorders. Through a clinical case series, various ocular conditions are reviewed, and the impact of OCT-A imaging is discussed. Although OCT-A imaging has great promise and is already used in clinical management, there is a lack of set standards to characterise altered vascular features in disease and consequently for prognostication, primarily due to a lack of large-scale clinical trials and variability in OCT-A algorithms when generating quantitative parameters.
Collapse
Affiliation(s)
- Michael Kalloniatis
- School of Medicine (Optometry), Deakin University, Waurn Ponds, VIC, Australia
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Henrietta Wang
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia
| | - Jack Phu
- School of Medicine (Optometry), Deakin University, Waurn Ponds, VIC, Australia
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
| | - Janelle Tong
- School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia
- Centre for Eye Health, University of New South Wales, Kensington, NSW, Australia
| | - James Armitage
- School of Medicine (Optometry), Deakin University, Waurn Ponds, VIC, Australia
| |
Collapse
|
2
|
Tong J, Alonso-Caneiro D, Kugelman J, Phu J, Khuu SK, Kalloniatis M. Characterisation of the normal human ganglion cell-inner plexiform layer using widefield optical coherence tomography. Ophthalmic Physiol Opt 2024; 44:457-471. [PMID: 37990841 DOI: 10.1111/opo.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE To describe variations in ganglion cell-inner plexiform layer (GCIPL) thickness in a healthy cohort from widefield optical coherence tomography (OCT) scans. METHODS Widefield OCT scans spanning 55° × 45° were acquired from 470 healthy eyes. The GCIPL was automatically segmented using deep learning methods. Thickness measurements were extracted after correction for warpage and retinal tilt. Multiple linear regression analysis was applied to discern trends between global GCIPL thickness and age, axial length and sex. To further characterise age-related change, hierarchical and two-step cluster algorithms were applied to identify locations sharing similar ageing properties, and rates of change were quantified using regression analyses with data pooled by cluster analysis outcomes. RESULTS Declines in widefield GCIPL thickness with age, increasing axial length and female sex were observed (parameter estimates -0.053, -0.436 and -0.464, p-values <0.001, <0.001 and 0.02, respectively). Cluster analyses revealed concentric, slightly nasally displaced, horseshoe patterns of age-related change in the GCIPL, with up to four statistically distinct clusters outside the macula. Linear regression analyses revealed significant ageing decline in GCIPL thickness across all clusters, with faster rates of change observed at central locations when expressed as absolute (slope = -0.19 centrally vs. -0.04 to -0.12 peripherally) and percentage rates of change (slope = -0.001 centrally vs. -0.0005 peripherally). CONCLUSIONS Normative variations in GCIPL thickness from widefield OCT with age, axial length and sex were noted, highlighting factors worth considering in further developments. Widefield OCT has promising potential to facilitate quantitative detection of abnormal GCIPL outside standard fields of view.
Collapse
Affiliation(s)
- Janelle Tong
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - David Alonso-Caneiro
- School of Science, Technology and Engineering, University of Sunshine Coast, Sunshine Coast, Queensland, Australia
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jason Kugelman
- Contact Lens and Visual Optics Laboratory, Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Jack Phu
- Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Concord Clinical School, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia
| | - Sieu K Khuu
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
- School of Medicine (Optometry), Deakin University, Waurn Ponds, Victoria, Australia
| |
Collapse
|
3
|
Ocansey S, Ekure E, Osuagwu UL, Ekpenyong BN, Ovenseri-Ogbomo G, Kyeremeh S, Ogbuehi KC, Agho KE, Mashige KP, Ndep AO, Naidoo KS. Profiling and factors associated with glaucoma diagnostic practice in sub-Saharan Africa-a cross sectional study of Nigerian and Ghanaian optometrists. BMC Ophthalmol 2023; 23:351. [PMID: 37553655 PMCID: PMC10410918 DOI: 10.1186/s12886-023-03083-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 07/14/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Ghana and Nigeria are the two countries in Africa that currently run the Doctor of Optometry (OD) program in sub-Saharan Africa (SSA). Optometrists in these countries are licensed to provide glaucoma care. Despite the clinically relevant practice guidelines for glaucoma, there is no data on the practice patterns for glaucoma eye care in SSA, a region with the highest prevalence of glaucoma. This study aimed to profile glaucoma diagnosis adherence to practice guidelines among optometrists in two neighbouring anglophone countries (Nigeria and Ghana). METHODS A web-based cross-sectional survey of practising optometrists was conducted in both countries. Each country data was weighted to reflect the total number of licensed and practising optometrists at the time of this survey. Descriptive analyses were performed against demography and practice factors using survey commands to adjust for sampling weights when estimating confidence intervals (CI) around prevalence estimates. Simple and multiple logistic regression analyses were performed to identify factors associated with glaucoma diagnosis. RESULTS A total of 493 optometrists (238, 48.3% and 255, 51.7%) from Ghana and Nigeria respectively, responded to the survey-the first to document and compare the glaucoma diagnostic criteria between optometrists in Ghana and Nigeria. More Ghanaian than Nigerian optometrists diagnosed glaucoma and over 90% in both countries reported that they frequently performed either tonometry, visual field testing, or fundus examination during glaucoma diagnosis. Ghanaian optometrists were significantly more likely to diagnose glaucoma than Nigerian optometrists (adjusted odd ratio, AOR = 6.15, 95%CI:1.63-23.15, P = .007). Optometrists who have practiced for more than 10 years (AOR = 7.04; 95%CI:1.74-28.47, P = .006) and private practice optometrists (AOR = 3.33; 95%CI:1.13-9.83, P = .03) were more likely to diagnose glaucoma. CONCLUSIONS The study provides information for evaluating glaucoma assessment for optometrists in both countries. Optometrists in both countries are reasonably well-equipped to diagnose glaucoma and are practicing at an adequate level, but with room for improvement.
Collapse
Affiliation(s)
- Stephen Ocansey
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Edgar Ekure
- Department of Biomedicine, Salus University, 8360 Old York Road, Elkins Park, PA, 19027, USA
| | - Uchechukwu L Osuagwu
- Bathurst Rural Clinical School (BRCS), School of Medicine, Western Sydney University, PO Box 9008, Bathurst, New South Wales, 2795, Australia.
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa.
| | - Bernadine N Ekpenyong
- Epidemiology and Biostatistics Unit, Department of Public Health, University of Calabar, Calabar, Cross River State, Nigeria
| | - Godwin Ovenseri-Ogbomo
- Department of Optometry, Centre for Health Sciences, University of the Highlands and Islands, Inverness, IV2 3JH, UK
| | - Sylvester Kyeremeh
- Department of Optometry and Visual Science, College of Science, KNUST, Kumasi, AK-385-1973, Ghana
| | - Kelechi C Ogbuehi
- Department of Medicine, Dunedin School of Medicine, University of Otago, Otago, New Zealand
| | - Kingsley E Agho
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa
- School of Health Science, Western Sydney University, Campbelltown, NSW, 2560, Australia
| | - Khathutshelo P Mashige
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa
| | - Antor O Ndep
- Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Kovin S Naidoo
- African Vision Research Institute, Discipline of Optometry, University of KwaZulu-Natal, Westville Campus, Durban, 3629, South Africa
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
4
|
Tong J, Khou V, Trinh M, Alonso‐Caneiro D, Zangerl B, Kalloniatis M. Derivation of human retinal cell densities using high-density, spatially localized optical coherence tomography data from the human retina. J Comp Neurol 2023; 531:1108-1125. [PMID: 37073514 PMCID: PMC10953454 DOI: 10.1002/cne.25483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 04/20/2023]
Abstract
This study sought to identify demographic variations in retinal thickness measurements from optical coherence tomography (OCT), to enable the calculation of cell density parameters across the neural layers of the healthy human macula. From macular OCTs (n = 247), ganglion cell (GCL), inner nuclear (INL), and inner segment-outer segment (ISOS) layer measurements were extracted using a customized high-density grid. Variations with age, sex, ethnicity, and refractive error were assessed with multiple linear regression analyses, with age-related distributions further assessed using hierarchical cluster analysis and regression models. Models were tested on a naïve healthy cohort (n = 40) with Mann-Whitney tests to determine generalizability. Quantitative cell density data were calculated from histological data from previous human studies. Eccentricity-dependent variations in OCT retinal thickness closely resemble topographic cell density maps from human histological studies. Age was consistently identified as significantly impacting retinal thickness (p = .0006, .0007, and .003 for GCL, INL and ISOS), with gender affecting ISOS only (p < .0001). Regression models demonstrated that age-related changes in the GCL and INL begin in the 30th decade and were linear for the ISOS. Model testing revealed significant differences in INL and ISOS thickness (p = .0008 and .0001; however, differences fell within the OCT's axial resolution. Qualitative comparisons show close alignment between OCT and histological cell densities when using unique, high-resolution OCT data, and correction for demographics-related variability. Overall, this study describes a process to calculate in vivo cell density from OCT for all neural layers of the human retina, providing a framework for basic science and clinical investigations.
Collapse
Affiliation(s)
- Janelle Tong
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
| | - Vincent Khou
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
| | - Matt Trinh
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
| | - David Alonso‐Caneiro
- School of Optometry and Vision ScienceCentre for Vision and Eye ResearchContact Lens and Visual Optics LaboratoryQueensland University of TechnologyQueenslandBrisbaneAustralia
- School of Science, Technology and EngineeringUniversity of Sunshine CoastQueenslandSippy DownsAustralia
| | - Barbara Zangerl
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- Coronary Care UnitRoyal Prince Alfred HospitalNew South WalesSydneyAustralia
| | - Michael Kalloniatis
- Centre for Eye HealthUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- School of Optometry and Vision ScienceUniversity of New South Wales (UNSW)New South WalesSydneyAustralia
- Department of OptometrySchool of MedicineDeakin UniversityVictoriaWaurn PondsAustralia
| |
Collapse
|
5
|
Vonk MC, Assassi S, Hoffmann-Vold AM. Scleroderma Skin: How Is Treatment Best Guided by Data and Implemented in Clinical Practice? Rheum Dis Clin North Am 2023; 49:249-262. [PMID: 37028833 DOI: 10.1016/j.rdc.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
Abstract
As skin involvement is the hall mark of systemic sclerosis (SSc) and changes of skin involvement have shown to correlate with internal organ involvement, assessing the extend of skin involvement is key. Although the modified Rodnan skin score is a validated tool used to evaluate the skin in SSc, it has its drawbacks. Novel imagine methods are promising but should be further evaluated. As for molecule markers for skin progression there are conflicting data on the predictive significance of baseline SSc skin gene expression profiles, but immune cell type signature in SSc skin correlates with progression.
Collapse
Affiliation(s)
- Madelon C Vonk
- Department of Rheumatology, Radboud University Nijmegen Medical Centre, Huispost 667, PO Box 9101, Nijmegen 6500HB, the Netherlands.
| | - Shervin Assassi
- Division of Rheumatology, The University of Texas Health Science Center at Houston, 6431 Fannin, Houston, TX, USA
| | - Anna-Maria Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital - Rikshospitalet, Pb 4950, Nydalen, Oslo 0424, Norway
| |
Collapse
|
6
|
The clinical features and the factors affecting visual prognosis in pediatric open-globe ınjuries. Int Ophthalmol 2022; 42:3589-3600. [PMID: 35579769 DOI: 10.1007/s10792-022-02359-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate clinical features and factors affecting visual prognosis after pediatric open-globe injuries. METHODS Retrospective study of 223 children with open-globe injury was conducted. Children with final logMAR visual acuity (LVA) > 0.70 were determined as poor-vision group (group 1, n = 108) and those with final LVA ≤ 0.70 as good-vision group (group 2, n = 115). Demographic characteristics (age, gender, and damaged eye), time between trauma and surgery, ocular trauma score (OTS), follow-up time, injury size, initial and final visual acuity levels, injury type (penetrating injury, globe rupture, perforating injury, and intraocular foreign body injury), injury localization (zone 1 = within the corneal and/or limbal area, zone 2 = within the scleral area extending 5 mm back from the limbus, and zone 3 = within the area posterior to zone 2), injury cause [metal objects (fork, knife, needle), broken glass, blunt objects (ball, punch), pen-pencil, and unidentified objects], and accompanying ocular findings of the groups were detected, and comparisons were done. Additionally, effects of age, time between trauma and surgery, OTS, injury size, follow-up time, initial LVA, injury type, and injury zone on final LVA were analyzed in both groups. RESULTS Mean age was 9.1 ± 2.0 years. There were 151 males and 72 females. Compared to group 1, group 2 had better initial and final visions (1.21 ± 0.26 vs 0.60 ± 0.28, p < 0.001 for initial LVA; 1.00 ± 0.32 vs 0.30 ± 0.13, p < 0.001 for final LVA), greater OTS (1.72 ± 0.53 vs 3.73 ± 0.61, p = 0.025), and smaller injury size (10.4 ± 3.5 vs 5.8 ± 2.4 mm, p = 0.002). Globe rupture (p = 0.015) and relative afferent pupillary defect (RAPD) (p = 0.037) were higher in group 1, while penetrating injury (p = 0.044), zone 1 involvement (p = 0.038), and metal object injury (p = 0.041) were higher in group 2. Based on multivariate analysis, the presences of globe rupture (p = 0.024) and RAPD (p = 0.035), the involvement without zone 1 (p = 0.042), and the injury without metal object (fork, knife, needle) (p = 0.046) were associated with poor final vision. Final LVA (for group 1 and group 2) was negatively correlated with OTS (r = - 0.398, p = 0.037; r = - 0.369, p = 0.040), while positively correlated with injury size (r = 0.412, p = 0.031; r = 0.318, p = 0.046) and initial LVA (r = 0.335, p = 0.043; r = 0.402, p = 0.034). CONCLUSION In our study, poor prognostic factors affecting final vision were low OTS, poor initial vision, the presences of globe rupture and RAPD, the large injury size, the involvement without zone 1, and the injury without metal object (fork, knife, needle).
Collapse
|
7
|
Nam J, Ly A, Kalloniatis M, Nivison-Smith L. Multispectral pattern recognition measures change in drusen area in age-related macular degeneration with high congruency to expert graders. Sci Rep 2022; 12:7442. [PMID: 35524159 PMCID: PMC9076877 DOI: 10.1038/s41598-022-11070-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/25/2022] [Indexed: 11/09/2022] Open
Abstract
Drusen are a hallmark lesion of age-related macular degeneration (AMD) and changes in their area and/or volume are strongly associated with disease progression. Assessment of longitudinal change in drusen size in clinical practice however is limited to a single commercial tool or manual inspection by clinicians. In this study we analysed change in drusen area in 33 eyes with intermediate AMD across two separate visits using a novel technique known as multispectral pattern recognition for en face retinal images from various imaging modalities (infrared (815 nm), fundus autofluorescence (488 nm) and green (532 nm) scanning laser ophthalmoscopy). We found 91% (30/33 eyes) agreement in the direction of drusen change for multispectral pattern recognition relative to expert graders who graded eyes as having drusen progression, regression or being stable. Multispectral pattern recognition showed 100% sensitivity (22/22 eyes) and 73% specificity (8/11 eyes). In comparison, we found only 70% (23/33 eyes) agreement in the direction of drusen change with a commercially available change analysis software, the Cirrus Advanced RPE Analysis relative to expert graders, with a sensitivity 64% (14/22 eyes) and specificity of 82% (9/11 eyes). Total drusen area or amount of change between visits had no significant effect on agreement. This suggests multispectral pattern recognition can quantify longitudinal change in drusen area from multimodal imaging with greater congruency to expert graders than a commercially available platform based on a single imaging modality. Considering the association of drusen area and disease progression, this method could aid clinical assessment and monitoring of AMD.
Collapse
Affiliation(s)
- Judy Nam
- Centre for Eye Health, University of New South Wales, Sydney, NSW, 2052, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Angelica Ly
- Centre for Eye Health, University of New South Wales, Sydney, NSW, 2052, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Sydney, NSW, 2052, Australia
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Lisa Nivison-Smith
- Centre for Eye Health, University of New South Wales, Sydney, NSW, 2052, Australia.
- School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, 2052, Australia.
| |
Collapse
|
8
|
DPSF: a Novel Dual-Parametric Sigmoid Function for Optical Coherence Tomography Image Enhancement. Med Biol Eng Comput 2022; 60:1111-1121. [PMID: 35233689 DOI: 10.1007/s11517-022-02538-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/13/2022] [Indexed: 10/19/2022]
Abstract
Speckle noise reduces the image contrast significantly making the highly scattering structures boundaries difficult to distinguish. This has limited the usage of optical coherence tomography (OCT) images in clinical routine and hindered its potential by depriving clinicians from assessing useful information that are needed in disease monitoring, treatment, progression, and decision making. To overcome this limitation, we propose a fast and robust OCT image enhancement framework using non-linear statistical parametric technique. In the proposed framework, we utilize prior statistical information to model the image to follow Gaussian distribution. After which, a newly designed dual-parametric sigmoid function (DPSF) is utilized to control the dynamic range and contrast level of the image. To balance the intensity range and contrast level, both linear and non-linear normalization operations are performed, then followed by a mapping operation to obtain the enhanced image. Experimentation results on the three OCT vendors show that the proposed method obtained high values in EME, PSNR, SSIM, ρ, and low value in MSE of 36.72, 38.87, 0.87, 0.98, and 25.12 for Cirrus; 40.77, 41.84, 0.89, 0.98, and 22.15 for Spectralis; and 30.81, 32.10, 0.81, 0.96, and 28.55 for Topcon OCT devices, respectively. The proposed DPSF framework performs better than the state-of-the-art methods and improves the interpretability and perception of the OCT images, which can provide clinicians and computer vision program with good quantitative and qualitative information.
Collapse
|
9
|
Ho S, Kalloniatis M, Ly A. Clinical decision support in primary care for better diagnosis and management of retinal disease. Clin Exp Optom 2022; 105:562-572. [PMID: 35025728 DOI: 10.1080/08164622.2021.2008791] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Misdiagnosis of retinal disease is a common problem in primary care that can lead to irreversible vision loss and false-positive referrals, resulting in inappropriate use of health services. Clinical decision support systems describe tools that leverage information technology to provide timely recommendations that assist clinicians in the decisions they make about the care of a patient. They, therefore, have the potential to reduce the rate of misdiagnosis by promoting evidence-based medicine and more effective and efficient healthcare. This narrative review aims to support primary care practitioners in better understanding the current and emerging capacity of clinical decision support systems in eye care. Different types of clinical decision support systems are discussed, using current examples and evidence from the available literature to demonstrate how they may improve diagnostic effectiveness and aid the management of retinal disease. Comments are made on the future directions of clinical decision support in primary eye care and the potential applications of artificial intelligence.
Collapse
Affiliation(s)
- Sharon Ho
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Angelica Ly
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| |
Collapse
|
10
|
Tong J, Yoshioka N, Alonso-Caneiro D, Zangerl B. Ganglion cell-inner plexiform layer measurements derived from widefield compared to montaged 9-field optical coherence tomography. Clin Exp Optom 2021; 105:822-830. [PMID: 34791988 DOI: 10.1080/08164622.2021.1993058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CLINICAL RELEVANCE With equivalent inner retinal thickness measurements compared to a more conventional composite optical coherence tomography (OCT) protocol, Widefield optical coherence tomography (WF-OCT) is a clinically viable, time-saving option facilitating detection of ocular pathologies within the central 55° of the retina. PURPOSE To compare ganglion cell-inner plexiform layer (GCIPL) thicknesses obtained using a single WF-OCT scan and standard composite OCT scans acquired in 9 fields of gaze (9F-OCT). METHODS Thirteen healthy participants underwent WF-OCT and 9F-OCT using the Spectralis OCT. The GCIPL was automatically segmented with a manual review for 9F-OCT and was manually segmented for WF-OCT. After registration, differences in GCIPL thicknesses were compared using 95% confidence intervals computed from one-sample t-tests and Bland-Altman analyses. Location-specific differences in B-scan tilt were analysed using Spearman correlations and linear regression models. To determine whether B-scan tilt influences GCIPL measurements, regression models of tilt versus differences between perpendicular and axial GCIPL thickness were applied. RESULTS While scattered locations demonstrated significant GCIPL thickness differences between WF-OCT and 9F-OCT, most differences did not exceed the axial pixel resolution of the instrument of 3.87 µm. Bland-Altman analyses indicated no notable bias using WF-OCT. Moderate correlations indicating significant location-specific differences in B-scan tilt were observed for temporal, central and inferior B-scans (r = -0.62 to 0.72), with linear regression models predicting a maximum difference in the tilt of 4.65°. The quadratic regression model indicated that at tilts greater than 27.3°, perpendicular GCIPL measurements become increasingly thin relative to axial measurements. CONCLUSIONS GCIPL thicknesses and B-scan tilts from WF-OCT are comparable to 9F-OCT, indicating that WF-OCT can be applied clinically to obtain valid inner retinal OCT measurements over 55° of the central retina with relative ease. However, for peripheral locations, B-scan tilt may need to be considered when measuring GCIPL thicknesses.
Collapse
Affiliation(s)
- Janelle Tong
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, Australia.,School of Optometry and Vision Science, UNSW, Sydney, Australia
| | - Nayuta Yoshioka
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, Australia
| | - David Alonso-Caneiro
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Barbara Zangerl
- School of Optometry and Vision Science, University of New South Wales (UNSW), Sydney, Australia.,School of Optometry and Vision Science, UNSW, Sydney, Australia
| |
Collapse
|
11
|
Blegen HM, Hobbs SD, Taylor R, Plaster AL, Drayna PM. A Comparison of Radial and Horizontal Macular Optical Coherence Tomography on Detection of Macular Pathology: A Prospective Study at an Academic Institution. JOURNAL OF VITREORETINAL DISEASES 2021; 5:501-504. [PMID: 37007179 PMCID: PMC9976148 DOI: 10.1177/2474126421997053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Optical coherence tomography (OCT) is useful in diagnosing and monitoring retinal pathology such as age-related macular degeneration, diabetic macular edema (DME), central serous chorioretinopathy, and epiretinal membrane, among others. This study compared the ability of horizontal (H) 25-, 13-, and 7-cut macular OCT vs 24-, 12-, and 6-cut radial (R) macular OCT in identifying various macular pathology. Methods: This was a prospective study of 161 established patients evaluated at Wilford Hall Eye Center Retina Clinic between September and October of 2019. Pathology included age-related macular degeneration, central serous chorioretinopathy, DME, and epiretinal membrane, among others. Patients obtained 25-, 13-, and 7-cut H raster OCT as well as 24-, 12-, and 6-cut R OCT. Primary outcomes were sensitivity in detecting macular fluid and each macular abnormality. Results: The 24-cut radial (R24) OCT equally or out-performed the H25 (horizontal 25-cut OCT) in detecting macular fluid across all pathological groups. Generally, a higher number of cuts correlated with better detection of fluid. In detecting any macular abnormalities, H25, R24, and R12 had 100% sensitivity. R6 OCT had near 100% sensitivity across all groups, except for DME (95%). Overall, R OCT had better sensitivity (0.960) than H OCT (0.907) in detecting macular pathology. Conclusions: R outperformed H macular OCT in detecting fluid and other abnormalities. Clinically, both scanning patterns can be used by ophthalmologists in diagnosis and management of commonly encountered macular diseases. Technicians may be able to use a variety of these scans to screen for pathology prior to physician evaluation.
Collapse
Affiliation(s)
- Halward M.J. Blegen
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, TX, USA
- Department of Ophthalmology, Wilford Hall Eye Center, San Antonio, TX, USA
| | - Samuel D. Hobbs
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, TX, USA
- Department of Ophthalmology, Wilford Hall Eye Center, San Antonio, TX, USA
| | - Reggie Taylor
- University of the Incarnate Word School of Osteopathic Medicine, San Antonio, TX, USA
| | - Andrew L. Plaster
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, TX, USA
- Department of Ophthalmology, Wilford Hall Eye Center, San Antonio, TX, USA
| | - Paul M. Drayna
- Department of Ophthalmology, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| |
Collapse
|
12
|
Ang JL, Collis S, Dhillon B, Cackett P. The Eye in Forensic Medicine: A Narrative Review. Asia Pac J Ophthalmol (Phila) 2021; 10:486-494. [PMID: 34524140 DOI: 10.1097/apo.0000000000000426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
ABSTRACT The eye, with its distinctive anatomy, not only reflects a wide variety of diseases in life but also undergoes a myriad of post-mortem changes. Consequently, the eye has long been an area of interest in forensic science, primarily for the estimation of post-mortem interval and therefore the time of death and also for assistance in ascertaining the cause of death. There has been significant progress in the knowledge of ophthalmic forensic science using new technologies which have allowed further possibilities to arise where understanding of this field can assist the forensic pathologist. This review aims to highlight the current knowledge which exists in this field and also to identify important avenues for further investigation. Post-mortem changes of the eye along with its current applications and challenges will be discussed. These include the important areas of post-mortem iris biometrics, pupil size correlation with post-mortem interval, use of point-of-care technology on vitreous humor, and the use of ophthalmic imaging in pediatric abusive head trauma.
Collapse
Affiliation(s)
- Juan Lyn Ang
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
| | - SallyAnne Collis
- Department of Forensic Pathology, The University of Edinburgh, Edinburgh, United Kingdom
| | - Baljean Dhillon
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
- The University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Cackett
- Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
- The University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
13
|
Bui BV, Downie LE, Lindsay RG. Optical coherence tomography: seeing the unseen. Clin Exp Optom 2021; 102:193-194. [DOI: 10.1111/cxo.12902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 03/03/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Bang V Bui
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Victoria, Australia,
| | - Laura E Downie
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Victoria, Australia,
| | | |
Collapse
|
14
|
Grace P, Evans BJW, Edgar DF, Patel PJ, Thomas D, Mahon G, Blake A, Bennett D. Investigation of the efficacy of an online tool for improving the diagnosis of macular lesions imaged by optical coherence tomography. JOURNAL OF OPTOMETRY 2021; 14:206-214. [PMID: 33132077 PMCID: PMC8093527 DOI: 10.1016/j.optom.2020.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 07/21/2020] [Accepted: 07/25/2020] [Indexed: 06/11/2023]
Abstract
PURPOSE Optical coherence tomography (OCT) is a non-invasive method for diagnosis and monitoring of retinal (typically, macular) conditions. The unfamiliar nature of OCT images can present considerable challenges for some community optometrists. The purpose of this research is to develop and assess the efficacy of a novel internet resource designed to assist optometrists in using OCT for diagnosis of macular disease and patient management. METHODS An online tool (OCTAID) has been designed to assist practitioners in the diagnosis of macular lesions detected by OCT. The effectiveness of OCTAID was evaluated in a randomised controlled trial comparing two groups of practitioners who underwent an online assessment (using clinical vignettes) based on OCT images, before (exam 1) and after (exam 2) an educational intervention. Participants' answers were validated against experts' classifications (the reference standard). OCTAID was randomly allocated as the educational intervention for one group with the control group receiving an intervention of standard OCT educational material. The participants were community optometrists. RESULTS Random allocation resulted in 53 optometrists receiving OCTAID and 65 receiving the control intervention. Both groups performed similarly at baseline with no significant difference in mean exam 1 scores (p = 0.21). The primary outcome measure was mean improvement in exam score between the two exam modules. Participants who received OCTAID improved their exam score significantly more than those who received conventional educational materials (p = 0.005). CONCLUSION Use of OCTAID is associated with an improvement in the combined skill of OCT scan recognition and patient management decisions.
Collapse
Affiliation(s)
- Paul Grace
- London South Bank University, UK; Institute of Optometry, London, UK.
| | - Bruce J W Evans
- London South Bank University, UK; Institute of Optometry, London, UK
| | - David F Edgar
- Division of Optometry and Visual Sciences, School of Health Sciences, City, University of London, London, United Kingdom
| | - Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | | | | | | | | |
Collapse
|
15
|
Phu J, Agar A, Wang H, Masselos K, Kalloniatis M. Management of open‐angle glaucoma by primary eye‐care practitioners: toward a personalised medicine approach. Clin Exp Optom 2021; 104:367-384. [DOI: 10.1111/cxo.13114] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jack Phu
- Centre for Eye Health, The University of New South Wales, Sydney, Australia
| | - Ashish Agar
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Henrietta Wang
- Centre for Eye Health, The University of New South Wales, Sydney, Australia
| | - Katherine Masselos
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | | |
Collapse
|
16
|
Tang V, Symons RCA, Guest D, McKendrick AM. An overview of optometrists' diabetic retinopathy practice patterns - a cross-sectional survey. Ophthalmic Physiol Opt 2021; 41:885-895. [PMID: 33682935 DOI: 10.1111/opo.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/21/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Contemporary eye care increasingly recommends the use of advanced retinal imaging technology. Anecdotal evidence suggests that this equipment is widely available in primary eye care settings; however, knowledge regarding how optometrists use this equipment in the context of diabetic retinopathy (DR) is limited. This study aimed to obtain a current overview of optometrists' clinical practice behaviours in the detection, screening, diagnosis and management of patients with diabetes. METHODS A cross-sectional survey was designed to evaluate optometrists' self-reported clinical practice patterns and perceptions, as well as the availability and impact of retinal imaging equipment specific to DR and diabetic macular oedema (DMO) on optometrists' clinical practice. The survey invited participation from all optometrists practising in Australia. RESULTS One hundred and sixty-seven optometrists participated. Optometrists' self-reported confidence in assessing DR and DMO was high. Optometrists' referral patterns considered the severity of DR and DMO before initiating referral to secondary ophthalmology care. Nearly all optometrists (98.8%) indicated that they had some form of retinal imaging equipment available to them in clinical practice. An optical coherence tomography (OCT) device was available to 75.5% of optometrists. A significant association between having an OCT device in the practice and higher self-reported confidence levels in the assessment of DMO was found. CONCLUSIONS Many optometrists are well equipped with sophisticated retinal imaging technology for the provision of high-quality eye care. Enhancing optometric training and education programmes can maximise the community benefit of access to this equipment and improve delivery of eye care in the community.
Collapse
Affiliation(s)
- Vanessa Tang
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Robert C Andrew Symons
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Daryl Guest
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
17
|
Zhang S, Phu J, Xu P, Wang H, Kalloniatis M, Zangerl B. The performance and confidence of clinicians in training in the analysis of ophthalmic images within a work-integrated teaching model. Ophthalmic Physiol Opt 2021; 41:768-781. [PMID: 33682940 DOI: 10.1111/opo.12795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE A fundamental clinical skill is the recognition of artefacts within the outputs of advanced imaging modalities. However, current teaching programmes of healthcare practitioners are becoming increasingly challenged to provide practical exposure within an already crowded curriculum. This study evaluates the impact of a novel work-integrated teaching model on the confidence and competence of clinicians in the use of optical coherence tomography (OCT) and the recognition of its artefacts. The outcomes were then used to develop a model to predict performance and guide teaching strategies. METHODS We prospectively evaluated a 6-week clinical placement for final year optometry students within a diagnostic eye clinic in 2018-2020. Participants completed a quiz on the identification of common OCT artefacts and rated their confidence levels on key areas of OCT application using a five-point Likert scale. Both were completed before (pre-rotation) and after (post-rotation) the placement. The cohort was divided into two groups; the first group was used to assess the impact of the placement and derive the prediction model for post-placement performance, which was then validated against the second group. RESULTS A significant improvement in detecting OCT imaging artefacts was seen upon completion of the placement, which was greater in participants with lower entry level performance. Across all OCT artefact subtypes, there was an improvement in detecting segmentation error, delineation error and media opacities. A model predicting post-placement student performance was developed using entry level knowledge base as the key dependent variable. Self-rated confidence improved across all domains of OCT application but was not found to be a direct predictor of actual performance. CONCLUSIONS These results highlight the benefit of a work-integrated learning programme on both academic performance and confidence whilst identifying entry level knowledge base as the key variable predicting improvement. Tailored teaching incorporating entering knowledge is the best predictor of improvement during clinical placements. Integrating clinicians into a work-integrated setting with tailored teaching and comprehensive practical exposure can be an effective method for training future or current healthcare professionals.
Collapse
Affiliation(s)
- Sophia Zhang
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Jack Phu
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Pauline Xu
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Henrietta Wang
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health, University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, University of New South Wales, Kensington, New South Wales, Australia
| |
Collapse
|
18
|
Wang H, Kalloniatis M. Clinical outcomes of the Centre for Eye Health: an intra-professional optometry-led collaborative eye care clinic in Australia. Clin Exp Optom 2021; 104:795-804. [PMID: 33689627 DOI: 10.1080/08164622.2021.1878821] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Clinical relevance: This novel clinical model is the first of its kind in Australia and was designed to help reduce unnecessary referrals into overburdened public systems by utilising pre-existing community-based resources.Background: The Centre for Eye Health (CFEH) is an intra-professional optometry-led care clinic offering an alternative pathway to traditional ophthalmology-based pathways (public hospital clinics or private practices) for 'at-risk' patients requiring ocular imaging, diagnostic and management services. This study evaluates the CFEH integrated eye-care model in the identification of chronic eye diseases within the community.Methods: A retrospective random clinical audit of over 750 medical records of patients referred to the CFEH between July 2016 and June 2019 was conducted. Demographics of patients, referral type, final diagnosis and recommended management plans were extracted from this subset. Clinic key performance indicators (referral turnaround time, and net cost per patient appointment) were also extracted.Results: Of the 755 referrals associated with the audited records, 77.4% resulted in the identification of patients with or at-risk of developing eye diseases with 73.5% of this cohort requiring ongoing monitoring at CFEH or referral to ophthalmology. Although the CFEH model is not designed to diagnose or manage acute conditions, 1.5% of patients in this pathway required same day ophthalmological or medical intervention. The cost per patient was equivalent to hospital eye departments costs.Conclusion: This integrated care pathway has the potential to reduce unnecessary referrals from optometrists to hospital ophthalmological service by offering a safe and effective alternate pathway. The majority of patients seen within this pathway were able to be monitored within optometry-led services. This is a unique clinical model utilising inter-professional referrals within optometry which has the potential to reduce preventable blindness within the community through the early detection of eye diseases.
Collapse
Affiliation(s)
- Henrietta Wang
- Centre for Eye Health, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, Sydney, Australia.,School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
| |
Collapse
|
19
|
Visualizing the Consistency of Clinical Characteristics that Distinguish Healthy Persons, Glaucoma Suspect Patients, and Manifest Glaucoma Patients. ACTA ACUST UNITED AC 2020; 3:274-287. [DOI: 10.1016/j.ogla.2020.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 11/18/2022]
|
20
|
Myakoshina EB, Saakyan SV. [Optical coherence tomography in diagnostics of small choroidal melanoma]. Vestn Oftalmol 2020; 136:56-64. [PMID: 32241970 DOI: 10.17116/oftalma202013601156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
PURPOSE To determine signs of small choroidal melanoma with different pigmentation using enhanced depth imaging optical coherence tomography (EDI-OCT). MATERIAL AND METHODS The study included 344 patients with small choroidal melanoma with different pigmentation examined using EDI-OCT: 1st group - pigmented melanoma (228 eyes), 2nd group - low pigmented (65 eyes), and 3rd group - amelanotic (51 eyes). RESULTS In pigmented small choroidal melanomas - elevation of choroidal profile towards vitreous, compression of choriocapillaries with a narrow even 'belt' and a 'shadow' effect; thinning, defects in Bruch's membrane; thickening of the retina above the tumor, lobulated photoreceptors; intra- and subretinal exudate (diffuse, cystic edema, neuroepithelial detachment); defects and detachment of pigment epithelium with hyperreflective foci, disorganization of the pigment with the formation of hyperreflective foci at different retinal levels. In low-pigmented small choroidal melanomas - elevation of choroidal profile towards vitreous, visualized inner surface of the sclera, 'excavation' of the choroid, enlarged choriocapillaries, contour of tumor; thickening of the retina, accumulation of intra- and subretinal exudate (local neuroepithelial detachments); disorganization of the pigment in pigment epithelium with hyperreflective foci in the outer retinal layers. In amelanotic small choroidal melanomas - elevation of choroidal profile towards vitreous, visualized inner surface of the sclera, 'excavation' of the choroid; contouring of choriocapillaries, longitudinal hyperreflective bands in the tumoral stroma, smoothness of the Bruch`s membrane, structural losses of photoreceptors; thickening of the retina (neuroepithelial detachment, diffuse edema); uneven thickening of pigment epithelium. CONCLUSION EDI-OCT can help identify microstructural changes in the choroid and adjacent retina in small choroidal melanomas with different degrees of pigmentation, suggesting at the early stages a more aggressive course of the tumoral process affecting the prognosis of the disease. In addition, identification of the microstructure and degree of pigmentation of initial choroidal melanomas is necessary for planning an organ-preserving treatment.
Collapse
Affiliation(s)
- E B Myakoshina
- Helmholtz National Medical Research Center of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - S V Saakyan
- Helmholtz National Medical Research Center of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| |
Collapse
|
21
|
Phu J, Hennessy MP, Spargo M, Dance S, Kalloniatis M. A collaborative care pathway for patients with suspected angle closure glaucoma spectrum disease. Clin Exp Optom 2019; 103:212-219. [PMID: 31119793 DOI: 10.1111/cxo.12923] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/01/2019] [Accepted: 04/15/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Currently, no specific collaborative care pathway exists that distinguishes open angle glaucoma from narrow angle or angle closure disease. This study evaluates a newly developed referral and collaborative care pathway specifically for patients with angle closure spectrum disease. METHODS The medical records of consecutive patients referred to the Centre for Eye Health for glaucoma assessment were examined, six months before (Pre Suite) and after (Post Suite) the introduction of a novel referral pathway for anterior chamber angle assessment (Angle Suite). Patient demographic and clinical data, the referral letter and practitioner characteristics were extracted. RESULTS Angle Suite (n = 77) patients had an appointment much sooner compared to Pre (n = 383) and Post Suite (n = 425) patients (p < 0.0001). Following the introduction of Angle Suites, there was a reduction of incidental angle closure disease found in routine, non-angle closure glaucoma assessment. Onward referral was required by 36.4 per cent of patients referred for suspected angle closure disease, while the rest could be discharged back into the community (13.0 per cent) or reviewed at the Centre for Eye Health (50.6 per cent). Multinomial logistic regression found that the presence of an angle description in the referral letter improved the true positive rate for angle closure disease (p < 0.0001). CONCLUSIONS The clinical pathway may reduce the number of incidental angle closure patients and improved the timeliness of appropriate clinical care delivered to a subset of patients who may benefit from prompt medical attention. This pathway provides an opportunity for appropriately staffed and equipped collaborative care clinics to reduce the burden on tertiary level ophthalmic facilities.
Collapse
Affiliation(s)
- Jack Phu
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| | - Michael P Hennessy
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Matthew Spargo
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Samuel Dance
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Kensington, New South Wales, Australia.,School of Optometry and Vision Science, The University of New South Wales, Kensington, New South Wales, Australia
| |
Collapse
|