Ophthalmic photography using a digital camera

PURPOSE: To report the application of a digital camera for ophthalmic photography in routine clinical use. METHODS: A digital camera (Nikon Coolpix 995) was used both for external macrophotography of the eye and ocular adnexa, and slitlamp photography of the anterior segment of the eye. RESULTS: We were able to take external macrophotographs under high magnification of the eye and ocular adnexa. Slitlamp photography could be performed under diffuse, slit beam, and retroillumination. The structures of the angle, the optic disc and surrounding retina could be photographed using appropriate lenses. The attachment to the operating microscope allowed intraoperative photography. It could also be attached to the laboratory microscope to capture images of various histopathology and microbiology slides. CONCLUSIONS: A digital camera is a versatile instrument for ophthalmic photography. It is easy to use in routine clinical practice and provides good quality photographs.     

A screening questionnaire for determining risk of Creuzfeldt-Jacob disease transmission during ophthalmic examination

INTRODUCTION: The risk of prion transmission during an ophthalmic examination concerns all ophthalmologists screening patients at risk, a procedure normally based on collecting past history and clinical data. PATIENTS AND METHODS: The authors proposed a shortened version of a questionnaire where the patient provides only the past history by answering three questions, which are then validated by the ophthalmologist. RESULTS: This procedure was proposed to 500 patients. Only five patients answered one of the questions positively, and the ophthalmologist did not use any contact device during their examination. Of these five patients, none was confirmed to be at risk for prion transmission. CONCLUSION: This questionnaire seems to be a suitable way to compensate the lack of time and reduced staff in ophthalmology, whatever the ophthalmic practice may be.     

The ophthalmologist's office: planning and practice. Patient traffic flow and use of paramedical personnel.

In order for the ophthalmologist to achieve the greatest earning power and personal satisfaction, he or she must devise traffic flow techniques that efficiently allow for maximum utilization of all examining areas and paramedical personnel in the office without dehumanizing patients. By delegating as much responsibility as possible to staff, the ophthalmologist will have the opportunity of performing his or her specialized skills to the fullest extent, and therefore will achieve optimal personal gratification. This emotional reward indemnifies the future of private practice, because it can exist only in the presence of a close patient-physician relationship, which is the cornerstone of the private practice of ophthalmology.     

The ophthalmologist and child victims of abuse

Among clinical manifestations of the battered child syndrome, ophthalmic manifestations play a prominent role in the recognition of this syndrome. From personal cases, the authors describe different ocular findings, specially intraocular hemorrhages with the important risk of sequelae. They show the role of the ophthalmologist among several situations. As the ophthalmologist may be the first to examine these traumatized infants his prompt recognition is important to take all necessary steps.     

How well-informed is the ophthalmology patient?

BACKGROUND: The patient responsibility concept is based on better informed patients who can shoulder the responsibility for their own health and who can discuss matters competently with their health care provider, becoming partners of their doctors in enabling them to make informed decisions about their medical care. Better patient information and more active participation is also often associated with greater patient satisfaction, improved compliance with treatment and therefore better quality as well as reduced cost health care. The aim of this study was to evaluate how well informed the ophthalmic patient is before visiting the ophthalmologist and what are his needs for additional information. MATERIALS AND METHODS: 106 patients seen in four ophthalmic practices in Switzerland completed a specifically developed and validated questionnaire. We recorded demographic and eye disease information, the time spent to get the information, the sources used, the degree of satisfaction achieved, the patient need for information as well as the sources and contents preferred. RESULTS: Only 36.8 % of the patients collected information prior to their ophthalmic consultation. Other physicians (50 % of the cases) and other patients (33.3 % of cases) were the most frequent information sources. Information was mainly collected about the ophthalmologist (61.8 % of the cases), and about the own eye diseases (20.6 %). Only 2.8 % of the patients spent more than 3 hours looking for information. 94.7 % of the patients wished to be orally informed in the practice. 74.7 % preferred to be informed only or also by the physician. CONCLUSIONS: Most ophthalmic patients do not represent the ideal of an informed patient. Without additional education they do not appear to have the knowledge or skill required for taking the responsibility for their own health.     

Screening for diabetic retinopathy using a digital non-mydriatic camera compared with standard 35-mm stereo colour transparencies

PURPOSE: To investigate the use of a digital non-mydriatic camera for determining the ETDRS clinical level of diabetic retinopathy, and to evaluate its use in a screening setting to appropriately determine the need for referral to an ophthalmologist (ETDRS level > or = 35). METHODS: A total of 83 patients with diabetes were photographed with and without pharmacological pupil dilation at an ophthalmology department using a digital non-mydriatic camera, obtaining two sets of five non-stereoscopic, 45 degree field images of each eye. ETDRS seven standard field, 35-mm stereoscopic colour fundus photographs were also obtained. A subgroup of 59 patients was photographed at an optician's shop using the digital non-mydriatic camera without pupil dilation. RESULTS: There was substantial agreement between the clinical level of diabetic retinopathy assessed from the 35-mm photographs and the digital images: the ophthalmology department (kappa = 0.76) with pupil dilation and (kappa = 0.66) without pupil dilation, respectively, and at the optician's (kappa = 0.60 without pupil dilation). With respect to the need for referral to an ophthalmologist, there was almost perfect agreement in the ophthalmology department (kappa = 0.88) with pupil dilation and (kappa = 0.84) without pupil dilation, respectively, and those taken at the optician's (kappa = 0.87 without pupil dilation). CONCLUSION: A digital non-mydriatic camera may be used in a screening situation to appropriately determine the need for referral to an ophthalmologist (ETDRS level > or = 35).     

Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with severe anemia secondary to idiopathic thrombocytopenic purpura

A 42-year-old female presented to us with a complaint of sudden painless loss of vision in both eyes of three days duration. Visual acuity was 20/100 for distance in both eyes. Fundus examination showed bilateral peripapillary hemorrhages, with subhyaloid and vitreous hemorrhage in both eyes. Hematological investigations revealed hemoglobin (HB 7 gm %) and severe thrombocytopenia (12,000/ ul). She was referred to a hematologist where a diagnosis of idiopathic thrombocytopenic purpura (ITP) was made. She was treated for systemic condition with regular ophthalmic follow-up. Over the next nine months, retinal hemorrhages completely resolved and the patient regained her visual acuity. The purpose of this case report is to highlight the clinical presentation of severe anemia, which is different from previous reports and the role of an ophthalmologist in first detecting the Idiopathic thrombocytopenic purpura (ITP), which led to successful recovery.     

Orbital pathology – Iatrogenic findings and artefacts

The relationship between the ophthalmologist and ophthalmic pathologist is particularly important in orbital disease, as diagnosis is heavily dependent on correlation with clinical context. If the patient has previously had treatment to the orbit or an adjacent area, whether for the same or a different condition, tissue changes may occur which affect the histological appearance of any specimen taken. This article is an overview of therapeutic interventions which may cause either orbital pathology or an altered appearance of the tissue, either of which can pose a diagnostic challenge. The problem of artefact is also addressed as another factor which may alter the appearance of a specimen. It is hoped that the information provided in this brief review will help clinicians better evaluate what information may be relevant when submitting a specimen.     

Arthur Thomas Paterson: the life and times of a New Zealand ophthalmologist

Arthur Thomas Paterson was a pre-eminent New Zealand ophthalmologist who settled in the United Kingdom after the First World War and became a leading figure in the development of ophthalmic services in the north-east of England. This vignette explores his contributions to clinical education and the establishment of comprehensive ophthalmic services in Newcastle upon Tyne. It also highlights the Arthur Thomas Paterson scholarship bequest to enable New Zealand ophthalmologists to acquire additional specialist training in inter-national centres of excellence.     

Automated quality evaluation of digital fundus photographs

Purpose: Retinal images acquired by means of digital photography are often used for evaluation and documentation of the ocular fundus, especially in patients with diabetes, glaucoma or age‐related macular degeneration. The clinical usefulness of an image is highly dependent on its quality. We set out to develop and evaluate an automatic method of evaluating the quality of digital fundus photographs. Methods: A method for making a numerical quantification of image sharpness and illumination was developed using Matlab? image analysis functions. Based on their sharpness and illumination measures, 1000 fundus photographs, randomly selected from a clinical database, were assigned to four predefined quality groups (not acceptable, acceptable, good, very good). Six independent observers, comprising three experienced ophthalmologists and three ophthalmic nurses with extensive experience in fundus image acquisition, classified a selection of 100 of these images into the corresponding quality groups. Results: Automatic quality evaluation was more sensitive than evaluation by human observers in terms of ability to discriminate between good and very good images. The median concordance between the six human observers and the automatic evaluation was substantial (kappa = 0.64). Conclusions: The proposed method provides an objective quality assessment of digital fundus photographs which agrees well with evaluations made by qualified human observers and which may be useful in clinical practice.     

眼科信息学的发展概述

信息技术的崛起并向各学科领域渗透是当今科学发展的一大趋势。眼科学与信息学交叉结合,诞生了眼科信息学。眼科信息学是以计算机为主要工具,借助眼科知识,开发和评估各种有关获取、处理及解释患者数据的方法和系统,将成为促进传统眼科学深入发展的新手段。为了让更多的眼科工作者了解眼科信息学知识并运用到实际工作中,笔者对眼科信息学的定义、原理、研究内容和方法进行了全面综述,同时列举了部分国内近年开展眼科信息学相关研究的实例,提出了眼科信息学研究内容的基本框架。（中华眼科杂志,2006,42：476-480）     

数字化图像分析在眼整形手术中的应用

客观、准确地测量眼睑位置可用于辅助眼整形手术术前诊断、医疗记录、评估手术疗效和教学、研究等方面.基于数字化图像的测量较临床手工测量更具优势,标准化的数字化图像为数据测量及图像处理提供了一种可重复性和可靠性更高的方法.规范化的相机位置、摄像参数、照明条件、背景及患者呈现状态可以提高照片质量.对常用数据的传统测量方法(手动...     

Acute retinal necrosis following epidural steroid injections

PURPOSE: To report a side effect of epidural corticosteroid injections for back pain. DESIGN: Case series. METHODS: Review of clinical charts and photographs. SETTING:Private retina practice.RESULTS: Two patients developed acute retinal necrosis syndrome following epidural corticosteroid injections for back pain. Referral was delayed in one patient. One patient developed bilateral secondary rhegmatogenous retinal detachment, and both developed secondary macular pucker. CONCLUSIONS: Acute retinal necrosis can follow epidural corticosteroid injections. Patients should be warned about this possibility and advised to report should photopsias, photosensitivity, blurred vision, or new floaters develop after treatment. Orthopedists should be aware of the complication and promptly refer patients with symptoms for dilated fundus examination by an ophthalmologist.     

Clinical description and review of migraine aura without headache.

BACKGROUND: Migraine aura without headache (MAWOH) is a type of migraine that seems to be reported more frequently in ophthalmic than neurologic or general medical practice. The clinical characteristics of this condition are described relative to its relationship with other forms of migraine, patient age, gender distribution, laterality, personal or family history, visual aura, and precipitating factors. As a result of its prevalence, it is a condition with which every optometrist and ophthalmologist should be familiar. Since MAWOH is a common cause of photopsia and transient vision loss, it is also important to consider it in the differential diagnosis of these conditions-especially in older patients. METHODS: The clinical investigations of MAWOH by prospective and retrospective case series are reviewed. This review includes an analysis by study of the number of patients, migraine history, and type of visual symptom. Comparison of clinical characteristics is used to distinguish MAWOH from other types of migraine. CONCLUSION: Migraine aura without headache is a type of migraine that is reported frequently in ophthalmic practice. Because it is related to photopsia and/or transient vision loss, specific clinical procedures should be performed to assist in the differential diagnosis of these conditions.     

Datenschutz und Umgang mit Patientendaten im Homemonitoring

Data security must be considered seriously in the context of telemedical home monitoring because of the transmission and communication of patients’ personal data. The contract governing medical treatment allows the ophthalmologist to process all data relevant to treatment. In Germany the legal framework for this purpose is provided by the Data Protection Act, various German hospital acts, and codes of medical professional conduct. In principle, these rules apply to telemedical home monitoring as well as to common physician–patient relationships. The patient must be informed extensively in an understandable manner and must give his or her written consent. However, the advanced options of new IT technologies demand the development of technical and organizational concepts that guarantee compliance with legal and regulatory affairs, assure data security, and prevent data abuse.     

Ophthalmologic diagnosis of hereditary hemorrhagic telangiectasia or Rendu-Osler-Weber disease

CASE REPORT: Our patient was a 45-year-old woman who had recurrent episodes of hematic epiphora, repeated epistaxes for which no cause was found and a family history of gastric hemorrhage. One of her daughters also suffered from spontaneous hemorrhages. DISCUSSION: Hereditary hemorrhagic telangiectasia is rarely diagnosed by an ophthalmologist; however the occurrence of bloody tears occurring spontaneously in a patient with epistaxis or gastric hemorrhage should lead to suspicion of hereditary hemorrhagic telangiectasia or Rendu-Osler-Weber disease. It should never be forgotten that clinical examination and appropriate investigations are basic components of disease diagnosis.     

Endovascular treatment of sinus dural fistulas using vein catheterism

PURPOSE: We report two techniques for treatment of dural arteriovenous fistulas using femoral vein catheterism and direct surgery via the superior ophthalmic vein. We will attempt to show the advantages of these new techniques instead of using the arterial pathway, which is currently the reference procedure. Subjects and method: Mrs G, 75 years old was sent by her ophthalmologist because of a suspected orbital tumor. Visual acuity: right eye: 3/10, exophthalmia, chemosis, with no thrill or murmur. The fundus examination was normal. The ultrasound exam with color Doppler imaging showed an arterialization of the superior ophthalmic vein compatible with an arteriovenous sinus dural fistula. Angio-MRI revealed a large left cavernous sinus, confirming the diagnosis. Considering the type of the fistula and the weak physical condition of the patient, we decided to attempt an endovascular embolization with coil placement, using femoral vein catheterism. Exophthalmia regressed within days. The fistula remains sealed 1 year after the procedure. Mr D, 40 years old, showed a similar clinical aspect of sinus dural fistula. We attempted an embolization with the femoral vein, which failed. We decided to embolize the cavernous sinus via the direct surgical pathway of the superior ophthalmic vein. Coils were placed and the fistula was sealed. CONCLUSION: These clinical cases show two less invasive alternatives giving better results than arterial embolization, the reference method (Brooks 1930; Spearmann 1964; Parkinson 1965), endovascular trapping, or surgery.     

Metastatic mesothelioma presenting with proptosis

PURPOSE: To describe the clinical presentation and histologic findings in a patient with metastatic mesothelioma presenting to the ophthalmologist with nonaxial proptosis. DESIGN: Case report. METHODS: A 55-year-old man presented with a short history of progressive ocular discomfort and vertical diplopia. Clinical examination identified nonaxial proptosis. Subsequent computed tomography showed a large extraconal mass consistent with a malignant process. Three months earlier the patient had been diagnosed with pleural mesothelioma. Unfortunately, he died 3 months after his ophthalmic presentation. Postmortem examination confirmed metastatic mesothelioma in the orbital roof that was histologically identical to the primary pleural malignancy. CONCLUSION: Pleural mesothelioma can metastasize to the orbit, causing proptosis.