Evidence for Telemedicine for Diabetic Retinal Disease

ABSTRACT

According to current projections, the number of Americans with diabetes mellitus will increase from 27.8 million in 2007 to 60.7 million in 2030. With the increasing gap between demand for eye care and supply of ophthalmologists and optometrists, and the non-uniform distribution of eye care providers in US counties, barriers to eye examinations will likely increase. Telemedicine assessment of diabetic retinal disease through remote retinal imaging and diagnosis has the potential to meet these growing demands. To establish evidence for a telemedicine program as an effective modality for diabetic retinopathy (DR) assessment, the interpretation of teleretinal images should compare favorably with Early Treatment Diabetic Retinopathy Study film or digital photographs. We review the current evidence on the critical features and characteristics of ocular telehealth programs for DR in the following categories: image gradability, mydriasis, sensitivity and specificity, cost-effectiveness, long-term effectiveness, patient comfort and satisfaction, and improvement of patient related outcomes.     

Test charts for distance preferred for low-vision

Two wall test charts with Snellen letters on both sides have been designed for the purpose of testing vision accurately, especially for the patient with low vision. Visual designations of 20/160 (6/48) and 20/125 (6/37.5) are included on the chart. This makes each line 26% larger. Sloan letters are used and arranged so that each line is of equal difficulty.     

Rationale for combination therapies for choroidal neovascularization

PURPOSE: To provide a conceptual framework for the development and use of combination therapies for choroidal neovascularization secondary to age-related macular degeneration. DESIGN: Literature review, integration of data, and creation of hypothesis. METHODS: An assessment of angiogenesis, cancer therapy, and inflammation was performed as they may pertain to choroidal neovascularization. A conceptual framework was created in which therapies for choroidal neovascularization could be evaluated alone or in combination. RESULTS: Angiogenesis occurs because cells produce angiogenic stimuli to encourage blood vessels to develop. This growth of vessels involves an orchestrated interaction among many mediators offering opportunity to modulate or inhibit the entire process. A two-component model for choroidal neovascularization is proposed. The vascular component of choroidal neovascularization is comprised of vascular endothelial cells, endothelial cell precursors, and pericytes. The extravascular component, which by histopathology appears to be both the source of angiogenic stimuli and often the largest component volumetrically, is comprised of inflammatory, glial and retinal pigment epithelial cells, and fibroblasts. Tissue damage can be caused by either component. Each component can be targeted through as variety of monotherapies. Combination therapies offer the possibility of attacking one component in more than one way or by attacking both components simultaneously. CONCLUSIONS: The two-component model of choroidal neovascularization can be used to evaluate the mechanism of action and possible interactions of these agents in a conceptual framework. Extension of these ideas can help guide development of new treatment agents and approaches.     

Book Review for Applied Pathology for Ophthalmic Microsurgeons

I am very honored being invited to write the book review for Applied Pathology for Ophthalmic Microsurgeons,of which the chief editor is Immediate Past-President of ICO/IFOS-Prof.Gottfried O.H.Naumann.This monograph is the latest     

Design considerations for a fluorophotometer for ocular research

Fluorometric studies have been made with modified slit-lamp microscopes. These instruments offered considerable versatility in modifying experimental parameters, but were seldom optimized in terms of detector and illuminator apertures, filter band-pass characteristics, detection system, light-source stabilization, or optical resolution. Improper control of these parameters can result in artifacts which override useful information.A new fluorophotometer for ocular research has been designed that utilizes an optical system, which eliminates the need for a contact lens. An effort was made to optimize both the axial resolution and the minimum detectable signal.The characteristics of standard barrier filters and excitation filters were examined and compared with photomultiplier sensitivity curves. It was necessary to use double filters in order to reduce artifacts due to excitation light that was not rejected by the barrier filter.In order to optimize the signal-to-noise ratio, a photon counting detection system was used. A dark current equivalent to 3 × 10^–10 g/ml allows a useful detection range of 1 × 10^–10 g/ml.     

Recruitment methods for community-based screening for diabetic retinopathy

Regular screening of all people with diabetes is the most efficient and cost-effective way to detect early stages of diabetic retinopathy so that laser treatment can be performed at the optimal time. A major aim of the Program for the Early Detection of Diabetic Retinopathy was to increase compliance with guidelines for screening for diabetic retinopathy. This community-based screening program used non-mydriatic retinal photography and was initiated in four areas of Victoria, Australia from 1996-1998. Recruitment strategies included targeted mail-outs, provision of the program brochure in English and the main languages spoken in the areas and media promotion in ethnic newspapers and on ethnic radio stations. In Victoria, only 55% of the population with diabetes currently access eye care services at the recommended intervals. This program was able to increase compliance with guidelines to 70% among people with diabetes that had not had a recent eye examination. A total of 1,197 people with diabetes were screened for diabetic retinopathy. Of the 1,197 people who were screened, 620 (15% of the estimated number of people with diabetes) had not had their eyes examined in the past two years. This pilot study identified strategies to encourage people with diabetes to have their eyes examined at the recommended intervals.     

防盲治盲可行途径的探索

目的:通过实践探讨防盲治盲可行途径,为基层农村开展防盲治盲工作提供借鉴。方法:通过多种途径的尝试,如:在基层县市建立眼专科医院和眼科研究所;与公立医院资源整合建立合作体;以股份制的形式参与其他专科医院的建设和经营;收购经营不善眼科医院;利用眼科流动手术车的形式深入各乡镇开展防盲治盲等。结果:在新会区建立眼科医院及研究所,在此基础上,与广东多家基层医院眼科合作,不同程度地提升了当地的眼科诊疗水平,但因相关政策改变而解除合作关系;以股份制的形式将普宁市杨庆寿眼科诊所转变成医院;收购海南眼科医院后,对医院的技术和管理都有很大的提高,转亏为盈,培养了一批眼科骨干,为防盲治盲工作配备了硬件和软件;以"江可伯"眼科流动手术车的形式深入山区和基层农村开展防盲治盲。结论:加强与社会各机构团体的合作,整合利用各种防盲资源,利用眼科流动手术车进行规模化的复明手术,降低运营成本,通过"结构脱盲""项目脱盲"和"监管脱盲"三管齐下,走出一条农村眼科事业发展的新道路。     

Book Review for Applied Pathology for Ophthalmic Microsurgeons

I am very honored being invited to write the book review forApplied Pathology for Ophthalmic Microsurgeonsof which the chief editor is Immediate Past-President of ICO/IFOS-Prof.Gottfried O.H.Naumann.This monograph is the latest masterpiece of Prof.Gottfried O.H.Naumann and other international top-class experts.Prof.Gottfried O.H.Naumann is an ophthalmologist of great attainments with solid     

Recruitment methods for community-based screening for diabetic retinopathy

Regular screening of all people with diabetes is the most efficient and cost-effective way to detect early stages of diabetic retinopathy so that laser treatment can be performed at the optimal time. A major aim of the Program for the Early Detection of Diabetic Retinopathy was to increase compliance with guidelines for screening for diabetic retinopathy. This community-based screening program used non-mydriatic retinal photography and was initiated in four areas of Victoria, Australia from 1996-1998. Recruitment strategies included targeted mail-outs, provision of the program brochure in English and the main languages spoken in the areas and media promotion in ethnic newspapers and on ethnic radio stations. In Victoria, only 55% of the population with diabetes currently access eye care services at the recommended intervals. This program was able to increase compliance with guidelines to 70% among people with diabetes that had not had a recent eye examination. A total of 1,197 people with diabetes were screened for diabetic retinopathy. Of the 1,197 people who were screened, 620 (15% of the estimated number of people with diabetes) had not had their eyes examined in the past two years. This pilot study identified strategies to encourage people with diabetes to have their eyes examined at the recommended intervals.     

Unmasking the mechanisms for Vernier acuity: evidence for a template model for Vernier acuity

The goal of this study was to evaluate the mechanisms underlying Vernier acuity, over a range of spatial scales using narrow-band Vernier stimuli and oblique masking. Specifically, the test stimuli consisted of a pair of vertical ribbons of horizontal cosine grating with a vertical Vernier offset between the ribbons. These stimuli have two important advantages for studying Vernier acuity: (1) they are relatively well localized in vertical spatial frequency, and (2) they are localized in their horizontal extent (width). We measured the orientation, spatial frequency and width tuning of Vernier acuity over a wide range of ribbon spatial frequencies, using a simultaneous oblique masking paradigm. Our masking results suggest that the mechanisms underlying Vernier acuity are tuned to the orientation, spatial frequency and width of the ribbon stimuli. The peak of the bimodal orientation tuning function varies systematically with the spatial frequency of the ribbon. The peak of the spatial frequency tuning function varies systematically with both the ribbon spatial frequency, and the ribbon width (i.e. the grating length). A 'template' model, in which the 'mechanism' is a windowed version of the stimulus is able to account for many features of the data, including results which cannot be easily accounted for by standard multi-scale filter models. Specifically, the template model can account for: (i) the bimodal orientation tuning function, (ii) the systematic variation in the peak of the orientation and spatial frequency tuning functions with spatial frequency, and (iii) the systematic effect of ribbon width on spatial frequency tuning.