Guidelines for Universal Eye Screening in Newborns Including RETINOPATHY of Prematurity
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Artificial Intelligence for Pediatric Ophthalmology
Artificial Intelligence for Pediatric Ophthalmology Julia E. Reid, MD m;y and Eric Eaton, PhDz Purpose of review Despite the impressive results of recent artificial intelligence (AI) applications to general ophthalmol- ogy, comparatively less progress has been made toward solving problems in pediatric ophthalmology using similar techniques. This article discusses the unique needs of pediatric ophthalmology patients and how AI techniques can address these challenges, surveys recent applications of AI to pediatric ophthalmology, and discusses future directions in the field. Recent findings The most significant advances involve the automated detection of retinopathy of prematurity (ROP), yielding results that rival experts. Machine learning (ML) has also been successfully applied to the clas- sification of pediatric cataracts, prediction of post-operative complications following cataract surgery, detection of strabismus and refractive error, prediction of future high myopia, and diagnosis of read- ing disability via eye tracking. In addition, ML techniques have been used for the study of visual development, vessel segmentation in pediatric fundus images, and ophthalmic image synthesis. Summary AI applications could significantly benefit clinical care for pediatric ophthalmology patients by opti- mizing disease detection and grading, broadening access to care, furthering scientific discovery, and improving clinical efficiency. These methods need to match or surpass physician performance in clinical trials before deployment with patients. Due to widespread use of closed-access data sets and software implementations, it is difficult to directly compare the performance of these approaches, and repro- ducibility is poor. Open-access data sets and software implementations could alleviate these issues, and encourage further AI applications to pediatric ophthalmology. Keywords pediatric ophthalmology, machine learning, artificial intelligence, deep learning INTRODUCTION atric ophthalmology, despite the pressing need. -
ICO Guidelines for Glaucoma Eye Care
ICO Guidelines for Glaucoma Eye Care International Council of Ophthalmology Guidelines for Glaucoma Eye Care The International Council of Ophthalmology (ICO) Guidelines for Glaucoma Eye Care have been developed as a supportive and educational resource for ophthalmologists and eye care providers worldwide. The goal is to improve the quality of eye care for patients and to reduce the risk of vision loss from the most common forms of open and closed angle glaucoma around the world. Core requirements for the appropriate care of open and closed angle glaucoma have been summarized, and consider low and intermediate to high resource settings. This is the first edition of the ICO Guidelines for Glaucoma Eye Care (February 2016). They are designed to be a working document to be adapted for local use, and we hope that the Guidelines are easy to read and translate. 2015 Task Force for Glaucoma Eye Care Neeru Gupta, MD, PhD, MBA, Chairman Tin Aung, MBBS, PhD Nathan Congdon, MD Tanuj Dada, MD Fabian Lerner, MD Sola Olawoye, MD Serge Resnikoff, MD, PhD Ningli Wang, MD, PhD Richard Wormald, MD Acknowledgements We gratefully acknowledge Dr. Ivo Kocur, Medical Officer, Prevention of Blindness, World Health Organization (WHO), Geneva, Switzerland, for his invaluable input and participation in the discussions of the Task Force. We sincerely thank Professor Hugh Taylor, ICO President, Melbourne, Australia, for many helpful insights during the development of these Guidelines. International Council of Ophthalmology | Guidelines for Glaucoma Eye Care International -
Differentiate Red Eye Disorders
Introduction DIFFERENTIATE RED EYE DISORDERS • Needs immediate treatment • Needs treatment within a few days • Does not require treatment Introduction SUBJECTIVE EYE COMPLAINTS • Decreased vision • Pain • Redness Characterize the complaint through history and exam. Introduction TYPES OF RED EYE DISORDERS • Mechanical trauma • Chemical trauma • Inflammation/infection Introduction ETIOLOGIES OF RED EYE 1. Chemical injury 2. Angle-closure glaucoma 3. Ocular foreign body 4. Corneal abrasion 5. Uveitis 6. Conjunctivitis 7. Ocular surface disease 8. Subconjunctival hemorrhage Evaluation RED EYE: POSSIBLE CAUSES • Trauma • Chemicals • Infection • Allergy • Systemic conditions Evaluation RED EYE: CAUSE AND EFFECT Symptom Cause Itching Allergy Burning Lid disorders, dry eye Foreign body sensation Foreign body, corneal abrasion Localized lid tenderness Hordeolum, chalazion Evaluation RED EYE: CAUSE AND EFFECT (Continued) Symptom Cause Deep, intense pain Corneal abrasions, scleritis, iritis, acute glaucoma, sinusitis, etc. Photophobia Corneal abrasions, iritis, acute glaucoma Halo vision Corneal edema (acute glaucoma, uveitis) Evaluation Equipment needed to evaluate red eye Evaluation Refer red eye with vision loss to ophthalmologist for evaluation Evaluation RED EYE DISORDERS: AN ANATOMIC APPROACH • Face • Adnexa – Orbital area – Lids – Ocular movements • Globe – Conjunctiva, sclera – Anterior chamber (using slit lamp if possible) – Intraocular pressure Disorders of the Ocular Adnexa Disorders of the Ocular Adnexa Hordeolum Disorders of the Ocular -
Peripapillary Retinal Vascular Involvement in Early Post-COVID-19 Patients
Journal of Clinical Medicine Article Peripapillary Retinal Vascular Involvement in Early Post-COVID-19 Patients 1,2, 1,2, 1,2, Alfonso Savastano y , Emanuele Crincoli y , Maria Cristina Savastano * , Saad Younis 3, Gloria Gambini 1,2, Umberto De Vico 1,2 , Grazia Maria Cozzupoli 1,2 , Carola Culiersi 1,2 , Stanislao Rizzo 1,2,4 and Gemelli Against COVID-19 Post-Acute Care Study Group 2 1 Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00196 Rome, Italy; [email protected] (A.S.); [email protected] (E.C.); [email protected] (G.G.); [email protected] (U.D.V.); [email protected] (G.M.C.); [email protected] (C.C.); [email protected] (S.R.) 2 Department of Ophthalmology, Catholic University of “Sacro Cuore”, 00168 Rome, Italy 3 Department of Ophthalmology, Western Eye Hospital, Imperial College Healthcare NHS Trust, London NW1 5QH, UK; [email protected] 4 Neuroscience Institute, Consiglio Nazionale delle Ricerche, Istituto di Neuroscienze, 56124 Pisa, Italy * Correspondence: [email protected]; Tel.: +39-063-015-4928 These authors contributed equally to this work. y Received: 5 August 2020; Accepted: 3 September 2020; Published: 8 September 2020 Abstract: The ability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-20s) to cause multi-organ ischemia and coronavirus-induced posterior segment eye diseases in mammals gave concern about potential sight-threatening ischemia in post coronavirus disease 2019 patients. The radial peripapillary capillary plexus (RPCP) is a sensitive target due to the important role in the vascular supply of the peripapillary retinal nerve fiber layer (RNFL). -
The Simplified Trachoma Grading System, Amended Anthony W Solomon,A Amir B Kello,B Mathieu Bangert,A Sheila K West,C Hugh R Taylor,D Rabebe Tekeraoie & Allen Fosterf
PolicyPolicy & practice & practice The simplified trachoma grading system, amended Anthony W Solomon,a Amir B Kello,b Mathieu Bangert,a Sheila K West,c Hugh R Taylor,d Rabebe Tekeraoie & Allen Fosterf Abstract A simplified grading system for trachoma was published by the World Health Organization (WHO) in 1987. Intended for use by non-specialist personnel working at community level, the system includes five signs, each of which can be present or absent in any eye: (i) trachomatous trichiasis; (ii) corneal opacity; (iii) trachomatous inflammation—follicular; (iv) trachomatous inflammation—intense; and (v) trachomatous scarring. Though neither perfectly sensitive nor perfectly specific for trachoma, these signs have been essential tools for identifying populations that need interventions to eliminate trachoma as a public health problem. In 2018, at WHO’s 4th global scientific meeting on trachoma, the definition of one of the signs, trachomatous trichiasis, was amended to exclude trichiasis that affects only the lower eyelid. This paper presents the amended system, updates its presentation, offers notes on its use and identifies areas of ongoing debate. Introduction (ii) corneal opacity; (iii) trachomatous inflammation—fol- licular; (iv) trachomatous inflammation—intense; and (v) tra- Trachoma is the most important infectious cause of blindness.1 chomatous scarring.19 Trachomatous inflammation—follicular Repeated conjunctival infection2 with particular strains of and trachomatous inflammation—intense are signs of active Chlamydia trachomatis3–5 -
Presbyopia and Glaucoma: Two Diseases, One Pathophysiology? the 2017 Friedenwald Lecture
Lecture Presbyopia and Glaucoma: Two Diseases, One Pathophysiology? The 2017 Friedenwald Lecture Paul L. Kaufman,1 Elke Lutjen¨ Drecoll,2 and Mary Ann Croft1 1Department of Ophthalmology and Visual Sciences, Wisconsin National Primate Research Center, McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin, United States 2Institute of Anatomy II, Erlangen, Germany Correspondence: Paul L. Kaufman, Department of Ophthalmology and Visual Sciences, University of Wisconsin Clinical Sciences Center, 600 Highland Avenue, Madison, WI 53792-3220, USA; [email protected]. Citation: Kaufman PL, Lutjen¨ Drecoll E, Croft MA. Presbyopia and glaucoma: two diseases, one pathophysiology? The 2017 Friedenwald Lecture. Invest Ophthalmol Vis Sci. 2019;60:1801–1812. https://doi.org/10.1167/iovs.19-26899 resbyopia, the progressive loss of near focus as we age, is choroid and the retina stretch in parallel with each other during P the world’s most prevalent ocular affliction. Accommoda- the accommodative response. The question remains how far tive amplitude is at its maximum (~15 diopters) in the teen back the accommodative choroid/retina movement goes. years and declines fairly linearly thereafter (Fig. 1).1 By age 25 By ‘‘marking’’ points on retinal photographs (e.g., vascular about half the maximum accommodative amplitude has been bifurcations) in aphakic (to avoid lens magnification artifacts lost, by age 35 two-thirds are gone, and by the mid-40s all is during accommodation) monkey eyes, movement of the retina gone. Clinical symptoms usually begin at age ~40. The during accommodation can be quantified in terms of both accommodative apparatus of the rhesus monkey is very similar direction and magnitude (Fig. -
Frequency of Common Factors Leading to Leukocoria in Pediatric Age Group at Tertiary Care Eye Hospital: an Observational Study
Biostatistics and Biometrics Open Access Journal ISSN: 2573-2633 Research Article Biostat Biometrics Open Acc J Faisal’s Issue - January 2018 Copyright © All rights are reserved by Muhammad Faisal Fahim DOI: 10.19080/BBOAJ.2018.04.555636 Frequency of Common Factors Leading to Leukocoria in Pediatric Age Group at Tertiary Care Eye Hospital: An Observational Study Rizwana Dargahi1, Abdul Haleem1, Darikta Dargahi S1 and Muhammad Faisal Fahim2* 1Department of Ophthalmology, Shaheed Mohtarma Benazir Bhutto Medical University, Pakistan 2Department of Research & Development, Al-Ibrahim Eye Hospital, Pakistan Submission: November 27, 2017; Published: January 19, 2018 *Corresponding author: Muhammad Faisal Fahim, M.Sc. (Statistics), Statistician, Department of Research & Development, Al-Ibrahim Eye Hospital, Isra postgraduate Institute of Ophthalmology, Karachi, Pakistan, Tel: ; Email: Abstract Objective: To know the frequency of common factors leading to leukocoria in pediatric age group at a tertiary care eye hospital. Materials & methods: This was across sectional observational study carried out at Pediatric department, Al-Ibrahim eye hospital Karachi from February to July 2016. All patients younger than 10 years who presented with leukocoria were included. The excluding criteria were previous history of trauma and ocular surgery. Systemic as well as ocular examination and relevant investigations was done to know cause of was used to analyzed data. leukocoria. B. Scan was done in all the cases. If needed X-ray chest, CT scan & MRI orbit was done for confirming diagnosis. SPSS version 20.0 Results: In our country congenital cataract is the most common cause of leukocoria which comprises about 77.3% (133/172) which is treatable. 2nd common cause was persistent fetal vasculature comprises 8.1% (14/172). -
Megalocornea Jeffrey Welder and Thomas a Oetting, MS, MD September 18, 2010
Megalocornea Jeffrey Welder and Thomas A Oetting, MS, MD September 18, 2010 Chief Complaint: Visual disturbance when changing positions. History of Present Illness: A 60-year-old man with a history of simple megalocornea presented to the Iowa City Veterans Administration Healthcare System eye clinic reporting visual disturbance while changing head position for several months. He noticed that his vision worsened with his head bent down. He previously had cataract surgery with an iris-sutured IOL due to the large size of his eye, which did not allow for placement of an anterior chamber intraocular lens (ACIOL) or scleral-fixated lens. Past Medical History: Megalocornea Medications: None Family History: No known history of megalocornea Social History: None contributory Ocular Exam: • Visual Acuity (with correction): • OD 20/100 (cause unknown) • OS 20/20 (with upright head position) • IOP: 18mmHg OD, 17mmHg OS • External Exam: normal OU • Pupils: No anisocoria and no relative afferent pupillary defect • Motility: Full OU. • Slit lamp exam: megalocornea (>13 mm in diameter) and with anterior mosaic dystrophy. Iris-sutured posterior chamber IOLs (PCIOLs), stable OD, but pseudophacodonesis OS with loose inferior suture evident. • Dilated funduscopic exam: Normal OU Clinical Course: The patient’s iris-sutured IOL had become loose (tilted and de-centered) in his large anterior chamber, despite several sutures that had been placed in the past, resulting now in visual disturbance with movement. FDA and IRB approval was obtained to place an Artisan iris-clip IOL (Ophtec®). He was taken to the OR where his existing IOL was removed using Duet forceps and scissors. The Artisan IOL was placed using enclavation iris forceps. -
Cataract Surgery & Glaucoma
worldclasslasik.com http://www.worldclasslasik.com/cataract-surgery-new-jersey/cataract-surgery-glaucoma/ Cataract Surgery & Glaucoma The lens of your eye is responsible for focusing light on the objects you see. If the lens is clouded, then you can’t see things clearly, and this is known as a cataract. It can form gradually over many years or you can be born with a cataract. For some people, cataracts are not even noticeable. They just find themselves turning on more lights to read or having trouble with glares while driving at night. Most cataracts are problematic later in life. It is estimated that more than half of all Americans over the age of 80 will have cataracts or have had them corrected with surgery. Another common eye problem for seniors is glaucoma. Glaucoma is actually a group of eye diseases that affect the optic nerve by causing various types of damage due to high pressure. The optic nerve carries images from the retina to the brain, so advanced glaucoma can actually impair vision to the point of blindness. It is actually the leading cause of blindness in the world. However, glaucoma can be remedied in a number of ways. Early detection and treatment by your eye surgeon are critical in achieving optimal results. Resolve Cataracts and Glaucoma with Surgery While many adults over the age of 65 suffer from both cataracts and glaucoma, it is important to note that the two are not related. Glaucoma does not cause cataracts and cataracts do not cause glaucoma. That being said, cataract surgery involves creating a small incision in the lens of the eye to remove the affected, or “cloudy” area of the lens. -
Albinism Terminology
Albinism Terminology Oculocutaneous Albinism (OCA): Oculocutaneous (pronounced ock-you-low-kew- TAIN-ee-us) Albinism is an inherited genetic condition characterized by the lack of or diminished pigment in the hair, skin, and eyes. Implications of this condition include eye and skin sensitivities to light and visual impairment. Ocular Albinism (OA): Ocular Albinism is an inherited genetic condition, diagnosed predominantly in males, characterized by the lack of pigment in the eyes. Implications of this condition include eye sensitivities to light and visual impairment. Hermansky Pudlak Syndrome (HPS): Hermansky-Pudlak Syndrome is a type of albinism which includes a bleeding tendency and lung disease. HPS may also include inflammatory bowel disease or kidney disease. The severity of these problems varies much from person to person, and the condition can be difficult to diagnose with traditional blood tests Chediak Higashi Syndrome: Chediak Higashi Syndrome is a type of albinism in which the immune system is affected. Illnesses and infections are common from infancy and can be severe. Issues also arise with blood clotting and severe bleeding. Melanin: Melanin is pigment found in a group of cells called melanocytes in most organisms. In albinism, the production of melanin is impaired or completely lacking. Nystagmus: Nystagmus is an involuntary movement of the eyes in either a vertical, horizontal, pendular, or circular pattern caused by a problem with the visual pathway from the eye to the brain. As a result, both eyes are unable to hold steady on objects being viewed. Nystagmus may be accompanied by unusual head positions and head nodding in an attempt to compensate for the condition. -
World Report on Vision Infographic
World report on vision The Facts Projected number of people estimated to have age related macular degeneration and glaucoma, 2020–2030. 243.4 million 195.6 million Everyone, if they live long enough, will experience at least one eye condition in their lifetime. Age related macular degeneration (any) Cataract surgery US$ 6.9 billion 95.4 million Refractive error 76 million US$ 7.4 billion Glaucoma 2020 2030 US$14.3 billion (is the investment) needed globally to treat existing Eye conditions are projected to unaddressed cases of refractive error and cataract. increase due to a variety of factors, including ageing population, lifestyle and NCDs. At least 2.2 billion people live with a vision impairment In at least 1 billion of these cases, vision impairment low- and middle- high-income regions could have been prevented income regions or has yet to be addressed Unaddressed distance vision impairment in many low- and middle- income regions is 4x higher than in high- income regions. Unaddressed refractive error (123.7 million) Cataract (65.2 million) Glaucoma (6.9 million) Corneal opacities (4.2 million) Diabetic Retinopathy (3 million) Trachoma (2 million) Unaddressed presbyopia (826 million) Eye conditions The problem Some eye conditions do not typically cause vision impairment, but others can. Common eye conditions that do not typically cause vision impairment Eyelid Conjunctivitis Dry eye Eyelid Conjunctivitis Dry eye Availability inflammation Accessibility Cyst or Stye Benign growth SubconjunctivalSubconjunctival in thethe eyeeye haemorrhagehaemorrhage Acceptability Common eye conditions that can cause vision impairment Eye care services are poorly integrated into health systems. The availability, accessibility and acceptability of eye Cataract Corneal opacity GlaucomaGlaucoma care services have an influence on eye conditions and vision impairment. -
Partial Albinism (Heterochromia Irides) in Black Angus Cattle
Partial Albinism (Heterochromia irides) in Black Angus Cattle C. A. Strasia, Ph.D.1 2 J. L. Johnson, D. V.M., Ph.D.3 D. Cole, D. V.M.4 H. W. Leipold, D.M.V., Ph.D.5 Introduction Various types of albinism have been reported in many Pathological changes in ocular anomalies of incomplete breeds of cattle throughout the world.4 We describe in this albino cattle showed iridal heterochromia grossly. paper a new coat and eye color defect (partial albinism, Histopathological findings of irides showed only the heterochromia irides) in purebred Black Angus cattle. In posterior layer fairly pigmented and usually no pigment in addition, the results of a breeding trial using a homozygous the stroma nor the anterior layer. The ciliary body showed affected bull on normal Hereford cows are reported. reduced amount of pigmentation and absence of corpora Albinism has been described in a number of breeds of nigra. Choroid lacked pigmentation. The Retina showed cattle.1,3-8,12,16,17 An albino herd from Holstein parentage disorganization. Fundus anomalies included colobomata of was described and no pigment was evident in the skin, eyes, varying sizes at the ventral aspect of the optic disc and the horns, and hooves; in addition, the cattle exhibited photo tapetum fibrosum was hypoplastic.12 In albino humans, the phobia. A heifer of black pied parentage exhibited a fundus is depigmented and the choroidal vessels stand out complete lack of pigment in the skin, iris and hair; however, strikingly. Nystagmus, head nodding and impaired vision at sexual maturity some pigment was present and referred to also may occur.