SDOCT Imaging to Identify Macular Pathology in Patients Diagnosed with Diabetic Maculopathy by a Digital Photographic Retinal Screening Programme

INTRODUCTION: Diabetic macular edema (DME) is an important cause of vision loss. England has a national systematic photographic retinal screening programme to identify patients with diabetic eye disease. Grading retinal photographs according to this national protocol identifies surrogate markers for DME. We audited a care pathway using a spectral-domain optical coherence tomography (SDOCT) clinic to identify macular pathology in this subset of patients. METHODS: A prospective audit was performed of patients referred from screening with mild to moderate non-proliferative diabetic retinopathy (R1) and surrogate markers for diabetic macular edema (M1) attending an SDOCT clinic. The SDOCT images were graded by an ophthalmologist as SDOCT positive, borderline or negative. SDOCT positive patients were referred to the medical retina clinic. SDOCT negative and borderline patients were further reviewed in the SDOCT clinic in 6 months. RESULTS: From a registered screening population of 17 551 patients with diabetes mellitus, 311 patients met the inclusion criteria between (March 2008 and September 2009). We analyzed images from 311 patients' SDOCT clinic episodes. There were 131 SDOCT negative and 12 borderline patients booked for revisit in the OCT clinic. Twenty-four were referred back to photographic screening for a variety of reasons. A total of 144 were referred to ophthalmology with OCT evidence of definite macular pathology requiring review by an ophthalmologist. DISCUSSION: This analysis shows that patients with diabetes, mild to moderate non-proliferative diabetic retinopathy (R1) and evidence of diabetic maculopathy on non-stereoscopic retinal photographs (M1) have a 42.1% chance of having no macular edema on SDOCT imaging as defined by standard OCT definitions of DME when graded by a retinal specialist. SDOCT imaging is a useful adjunct to colour fundus photography in screening for referable diabetic maculopathy in our screening population

Reflections from Education and the Arts in the COVID-19 Era. Reflections XIX, XX

Dipti Desai developed Reflection XIX. Desai is a Professor of Art and Art Education and she is a reference in the field of art education in activist contexts. She is also Director of Art +Education Programs, Department of Art and Art Professions, Steinhardt School of Culture, Education and Human Development, New York University. Reflection XX is developed by Naisha B. Solomon and Amanda Charnley, graduate students in the Art, Education, and Community Practice program in the Department of Art and Art Professions, Steinhardt School of Culture, Education and Human Development, New York University.Dipti Desai firma la Reflexión XIX. Desai es profesora de arte y educación artística de referencia en el ámbito educativo artístico en contextos activistas, directora del Programa Arte+Educación en el departamento de Arte y Profesiones Artísticas, de la Steinhardt School de Cultura, Educación y Humanidades, Universidad de Nueva York. La Reflexión XX está desarrollada por Naisha B. Solomon y Amanda Charnley, estudiantes de posgrado del programa de Arte, Educación y Práctica Comunitaria del Departamento de Arte y Profesiones Artísticas de la Escuela de Cultura, Educación y Desarrollo Humano, Universidad de Nueva York.Dipti Desai assina a Reflexão XIX. Desai é professora de arte e educação artística de referência no campo da educação artística em contextos ativistas, diretora do Programa Arte+Educação no Departamento de Artes e Profissões Artísticas da Steinhardt School of Culture, Education and Humanities, New York University. Reflexão XX é desenvolvido por Naisha B. Solomon e Amanda Charnley, estudantes de pós-graduação do programa Arte, Educação e Prática Comunitária do Departamento de Artes e Profissões Artísticas da Escola de Cultura, Educação e Desenvolvimento Humano da New York University

Workload reduction versus referable sensitivity for the four automated strategies.

<p>The arrows indicate the 95% confidence intervals on the measurements.</p

Receiver operator characteristic (ROC) plot for all the graders who took part in the external arbitration.

<p>The three levels of grader (primary, secondary and arbitration) are shown by ‘*’, ‘+’ and ‘o’ respectively. All the graders were compared against a consensus grading calculated from the results from all the arbitration level graders. Notice even amongst the arbitration level graders there is a range of operating points from high specificity and lower sensitivity to high sensitivity and lower specificity.</p

Retinopathy and maculopathy grading scheme for the English National Screening Programme for Diabetic Retinopathy.

<p>Retinopathy and maculopathy grading scheme for the English National Screening Programme for Diabetic Retinopathy.</p

Performance of the four automated strategies for detecting different grades of disease, together with the associated workload reduction.

<p>Performance of the four automated strategies for detecting different grades of disease, together with the associated workload reduction.</p

Comparison of per patient sensitivities and workload reduction from this study and three Scottish studies using the same software.

<p>Note that study <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0027524#pone.0027524-Fleming1" target="_blank">[4]</a> is the only one that apparently missed proliferative disease. However, subsequent re-grading of the six supposed proliferative cases downgraded all cases to non-referable (the six images in question are available as supplementary material from the BJO website).</p

Implementation of medical retina virtual clinics in a tertiary eye care referral centre.

BACKGROUND The increasing incidence of medical retinal diseases has created capacity issues across UK. In this study, we describe the implementation and outcomes of virtual medical retina clinics (VMRCs) at Moorfields Eye Hospital, South Division, London. It represents a promising solution to ensure that patients are seen and treated in a timely fashion METHODS: First attendances in the VMRC (September 2016-May 2017) were included. It was open to non-urgent external referrals and to existing patients in a face-to-face clinic (F2FC). All patients received visual acuity testing, dilated fundus photography and optical coherence tomography scans. Grading was performed by consultants, fellows and allied healthcare professionals. Outcomes of these virtual consultations and reasons for F2FC referrals were assessed. RESULTS A total number of 1729 patients were included (1543 were internal and 186 external referrals). The majority were diagnosed with diabetic retinopathy (75.1% of internal and 46.8% of external referrals). Of the internal referrals, 14.6% were discharged, 54.5% continued in VMRC and 30.9% were brought to a F2FC. Of the external referrals, 45.5% were discharged, 37.1% continued in VMRC and 17.4% were brought to a F2FC. The main reason for F2FC referrals was image quality (34.7%), followed by detection of potentially treatable disease (20.2%). CONCLUSION VMRC can be implemented successfully using existing resources within a hospital eye service. It may also serve as a first-line rapid-access clinic for low-risk referrals. This would enable medical retinal services to cope with increasing demand and efficiently allocate resources to those who require treatment

OCT clinic pathway.

<p>The number of patients identified in this study at each section of this pathway are highlighted. Note that any R2 and R3 identified at primary screening are referred directly to ophthalmology clinic and do not enter the SDOCT clinical pathway represented in Figure 1.</p