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Nonmydriatic Fundus Photography in Patients with Acute Vision Loss
摘要： Background: Acute visual loss is a common chief complaint in emergency department (ED) patients, but the scarcity of ophthalmologists in most EDs limits its evaluation. Introduction: Our objective was to evaluate whether non-mydriatic fundus photography (NMFP) in the ED helps triage patients with acute visual loss. Materials and Methods: We included 213 patients with acute visual loss evaluated in the ED with NMFP as part of the Fundus Photography versus Ophthalmoscopy Trial Outcomes in the ED studies. Demographics, referral patterns, results of NMFP, and final diagnoses were recorded. Results: A final ophthalmological diagnosis was made in 109/213 (51%) patients. NMFP allowed a definite diagnosis in 51/109 (47%) patients: 14 nonglaucomatous optic neuropathies, 10 papilledema, 13 acute retinal ischemia, 2 retinal detachments, 2 choroidal metastases, 4 maculopathies, and 6 glaucoma. In 58/109 (53%) patients, NMFP was not diagnostic even when interpreted remotely by ophthalmologists due to disorders undiagnosable with NMFP. Ophthalmology consultation was requested in 109/213 (51%) patients, 41/54 (76%) patients with abnormal NMFP versus 68/159 (43%) patients with normal NMPF (p < 0.001). Discussion: Although NMFP allowed rapid diagnosis in 51/213 (24%) patients presenting to the ED with acute visual loss, NMFP alone was not sufficient to detect all ocular diseases; ophthalmology consultation was more often requested when NMFP was abnormal. Conclusions: Our study emphasizes the limitations of tele-ophthalmology with NMFP in remotely detecting ocular diseases related to acute visual loss in the ED. NMFP helped triage and referral decisions and can be used to complement ophthalmology consultations in the ED.
关键词： telehealth,acute vision loss,teleophthalmology,nonmydriatic fundus photography,emergency department,ocular pathology detection
更新于2025-09-23 15:19:57
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A DOUBLE-MASKED, RANDOMIZED, SHAM-CONTROLLED, SINGLE-CENTER STUDY WITH PHOTOBIOMODULATION FOR THE TREATMENT OF DRY AGE-RELATED MACULAR DEGENERATION
摘要： The LIGHTSITE I study investigated the efficacy and safety of photobiomodulation (PBM) treatment in subjects with dry age-related macular degeneration. Thirty subjects (46 eyes) were treated with the Valeda Light Delivery System, wherein subjects underwent two series of treatments (3· per week for 3–4 weeks) over 1 year. Outcome measures included best-corrected visual acuity, contrast sensitivity, microperimetry, central drusen volume and drusen thickness, and quality of life assessments. Photobiomodulation-treated subjects showed a best-corrected visual acuity mean letter score gain of 4 letters immediately after each treatment series at Month 1 (M1) and Month 7 (M7). Approximately 50% of PBM-treated subjects showed improvement of $5 letters versus 13.6% in sham-treated subjects at M1. High responding subjects ($5-letter improvement) in the PBM-treated group showed a gain of 8 letters after initial treatment (P , 0.01) and exhibited earlier stages of age-related macular degeneration disease. Statistically significant improvements in contrast sensitivity, central drusen volume, central drusen thickness, and quality of life were observed (P , 0.05). No device-related adverse events were reported. Photobiomodulation treatment statistically improved clinical and anatomical outcomes with more robust benefits observed in subjects with earlier stages of dry age-related macular degeneration. Repeated PBM treatments are necessary to maintain benefits. These pilot findings support previous reports and suggest the utility of PBM as a safe and effective therapy in subjects with dry age-related macular degeneration.
关键词： contrast sensitivity,best-corrected visual acuity,light-emitting diode,vision loss,low-level light therapy,mitochondria,photobiomodulation,dry age-related macular degeneration,drusen
更新于2025-09-12 10:27:22
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Optical Coherence Tomography Study of Retinal Changes in Normal Aging and After Ischemia
摘要： PURPOSE. Age-related thinning of the retinal ganglion cell axons in the nerve ?ber layer has been measured in humans using optical coherence tomography (OCT). In this study, we used OCT to measure inner retinal changes in 3-month-, 1-year-, and 2-year-old mice and after experimental anterior ischemic optic neuropathy (AION). METHODS. We used OCT to quantify retinal thickness in over 200 eyes at different ages before and after a photochemical thrombosis model of AION. The scans were manually or automatically segmented. RESULTS. In normal aging, there was 1.3-lm thinning of the ganglion cell complex (GCC) between 3 months and 1 year (P < 0.0001) and no further thinning at 2 years. In studying age-related inner retinal changes, measurement of the GCC (circular scan) was superior to that of the total retinal thickness (posterior pole scan) despite the need for manual segmentation because it was not contaminated by outer retinal changes. Three weeks after AION, there was 8.9-lm thinning of the GCC (circular scan; P < 0.0001), 50-lm thinning of the optic disc (posterior pole scan; P < 0.0001), and 17-lm thinning of the retina (posterior pole scan; P < 0.0001) in the 3-month-old group. Changes in the older eyes after AION were similar to those of the 3-month-old group. CONCLUSIONS. Optical coherence tomography imaging of a large number of eyes showed that, like humans, mice exhibited small, age-related inner retinal thinning. Measurement of the GCC was superior to total retinal thickness in quantifying age-related changes, and both circular and posterior pole scans were useful to track short-term changes after AION.
关键词： vision loss,optic neuropathy,aging,retinal ganglion cell,optical coherence tomography,animal model,anterior ischemic optic neuropathy
更新于2025-09-11 14:15:04
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Molecular Diagnosis of Inherited Retinal Diseases in Indigenous African Populations by Whole-Exome Sequencing
摘要： PURPOSE. A majority of genes associated with inherited retinal diseases (IRDs) have been identi?ed in patients of European origin. Indigenous African populations exhibit rich genomic diversity, and evaluation of reported genetic mutations has yielded low returns so far. Our goal was to perform whole-exome sequencing (WES) to examine variants in known IRD genes in underrepresented African cohorts. METHODS. Whole-exome sequencing was performed on 56 samples from 16 families with diverse IRD phenotypes that had remained undiagnosed after screening for known mutations using genotyping-based microarrays (Asper Ophthalmics). Variants in reported IRD genes were identi?ed using WES and validated by Sanger sequencing. Custom TaqMan assays were used to screen for identi?ed mutations in 193 unrelated indigenous Africans with IRDs. RESULTS. A total of 3494 variants were identi?ed in 217 known IRD genes, leading to the identi?cation of seven different mutations (including six novel) in six genes (RHO, PRPF3, PRPF31, ABCA4, CERKL, and PDE6B) in six distinct families. TaqMan screening in additional probands revealed identical homozygous CERKL and PDE6B variants in four more patients. CONCLUSIONS. This is the ?rst report of WES of patients with IRDs in indigenous African populations. Our study identi?ed genetic defects in almost 40% of the families analyzed, signi?cantly enhancing the molecular diagnosis of IRD in South Africa. Thus, WES of understudied cohorts seems to present an effective strategy for determining novel mutations in heterogeneous retinal diseases.
关键词： genetic testing,vision loss,inherited blindness,South Africa,retinal degeneration,next generation sequencing,photoreceptor dysfunction,clinical genetics
更新于2025-09-11 14:15:04
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Diabetic Nephropathy (Pathophysiology and Clinical Aspects) || Microvascular Complications in the?Eye: Diabetic Retinopathy
摘要： Diabetic retinopathy (DR) is a major cause of vision loss and blindness among persons with diabetes mellitus. It is estimated that approximately 35% of diabetes patients develop some form of DR [1]. DR is a progressive disease that is predominantly characterized by alterations in the retinal microvasculature. It may develop from an asymptomatic nonproliferative form associated with capillary non-perfusion, microaneurysms, and retinal hemorrhages, into a vision-threating disorder such as diabetic macular edema (DME) and proliferative DR (PDR).
关键词： vision loss,Diabetic retinopathy,retinal microvasculature,blindness,microvascular complications,diabetic macular edema,diabetes mellitus,proliferative diabetic retinopathy
更新于2025-09-10 09:29:36
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Changes in Fixation Stability with Time during Binocular and Monocular Viewing in Maculopathy
摘要： The purpose of this study was to examine changes in ?xation stability over time during binocular and monocular viewing in patients with age-related macular degeneration (AMD). Seventeen patients with AMD and 17 controls were enrolled. Using an EyeLink eyetracker (SR Research Ltd., Mississauga, Ontario, Canada), ?xation stability was recorded binocularly and monocularly with each eye for a duration of 15 s while the fellow eye was covered. Fixation stability was analyzed over 3 s intervals for each condition using a 68% bivariate contour ellipse area. Fixation stability did not change with time during binocular viewing for both groups, both monocular conditions for the control group, and monocular viewing with the better eye for the AMD group. However, during monocular viewing with the worse eye, the test of within-subject contrasts showed linear improvement in ?xation stability with time (p = 0.016). In conclusion, in patients with AMD, monocular ?xational control with the worse eye is poor, but improves with time.
关键词： ?xation duration,worse eye,age-related macular degeneration,?xation stability,preferred retinal locus,central vision loss
更新于2025-09-10 09:29:36