The role of OCT-A in retinal disease management

Optical coherence tomography angiography (OCT-A) is a non-invasive, non-dye-based imaging modality that has the potential to enhance our understanding of retinal diseases. While this rapidly advancing imaging modality offers great potential, there is a need for community-wide understanding of the range of technologies and methods for interpreting the images, as well as a need to enhance understanding of images from disease-free eyes for reference when screening for retinal diseases. Importantly, clinical trials have been designed without OCT-A-based endpoints; therefore, caution is required when making treatment decisions based on OCT-A imaging alone. With this in mind, a full understanding of the advantages and limitations of OCT-A will be vital for effective development of the technique within the field of ophthalmology. On behalf of the Vision Academy Steering Committee (sponsored by Bayer), this publication summarizes the views of the authors on the current use of OCT-A imaging and explores its potential for future applications in research and clinical practice

Multifocal VEP (mfVEP) reveals abnormal neuronal delays in diabetes

This pilot study examined the diagnostic role of multifocal visually evoked potentials (mfVEP) in a small number of patients with diabetes. mfVEP, mfERG, and fundus photographs of both eyes of five patients with diabetes, three with nonproliferative diabetic retinopathy (NPDR) and two without NPDR were examined. Thirteen control subjects were also examined. Eighteen zones were constructed from the 60-element mfVEP stimulus array. mfVEP implicit time (IT) and amplitude (SNR) differences were tested between subject groups. We also examined whether there was a difference in function for patches with and without retinopathy in the NPDR group. Lastly, we compared mfVEP and mfERG results in the same patients. We found significant mfVEP IT differences between controls and all patients with diabetes, controls and diabetics without retinopathy, and between controls and diabetics with retinopathy. The subject groups did not differ significantly in terms of SNR. In the retinopathy group, ITs from zones with retinopathy were significantly longer than ITs from zones without retinopathy (P = 0.016). mfERG IT was more frequently abnormal than mfVEP IT. In addition, mfERG hexagons were twice as likely to be abnormal if the corresponding mfVEP zone was abnormal (P < 0.05). mfVEP implicit times are significantly delayed in patients with diabetes even when there is no retinopathy. These cortical response results are similar, albeit considerably less abnormal, than those previously reported for retinal (mfERG) responses in patients with diabetes. A correlation exists between the location of abnormal mfERG hexagons and abnormal mfVEP zones

An Investigation of Teacher/Pupils Ratios on the Internal Efficiency Indicators of Mvomero District and Morogoro Municipality

This study investigated the Teacher/Pupils Ratios on the Internal Efficiency Indicators of Mvomero District and Morogoro Municipal. Five objectives were set; the Teacher Pupils Ratio for remote and peripheral schools compared to urban schools against internal efficiency parameters such as, the dropout rate, the transition rate, the pass rate, and the repetition rates. Methodologically both qualitative and quantitative approaches were used for data collection and analysis. Focused group discussions (FGD), semi–structured interviews, questionnaires and unpublished documentary reviews were used as instruments for data collection. The results of this study show that there are wide TPR between Morogoro urban 1:48 and Mvomero district 1:58; concerning dropout rates there are differences between Morogoro Municipality and Mvomero district schools. In terms of repetition rate the findings indicate that there is difference of 15 per cent between Morogoro urban with an average of 37 per cent in Mvomero district schools with an average of 22 per cent for Morogoro municipality schools. The transition rate shows that there is a lower transition rate in Mvomero district schools of 62 per cent compared to Morogoro Municipality of 82 per cent. The pass rate in Mvomero district schools was 74 per cent compared to Morogoro urban schools of 96 per cent. The remotely located schools in Mvomero are not attractive to teachers because they lack essential services as indicated in the text. It is recommended that the Government provide hardship allowances or the schools advertise the vacancies so that those who apply are those prepared to live and work in the remote and peripheral locations

Treatment algorithm with dexamethasone intravitreal implant in patients with diabetic macular edema

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CURRENT CONCEPTS AND MODALITIES FOR MONITORING THE FELLOW EYE IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: An Expert Panel Consensus

PURPOSE: The presence of neovascular age-related macular degeneration (nAMD) in one eye is a major risk factor for the development of disease in the fellow eye. Several methods exist to help physicians monitor the fellow eye, with new technologies becoming increasingly available. METHODS: We provide an overview of modalities for nAMD monitoring, including advances in home-based options, and review their utility for fellow-eye monitoring, based on a review of the literature and a consensus of retinal experts. RESULTS: Studies demonstrate the importance of early detection of nAMD in the fellow eye so that interventions can be made before significant vision loss occurs. A series of techniques exist for the early detection of nAMD including chart-based methods and imaging devices. The increased availability of home-based methods has presented an opportunity for patients to monitor their vision at home. CONCLUSION: Frequent monitoring of the fellow eye in patients with unilateral nAMD is of critical importance to prevent vision loss and maintain quality of life. Patients should be examined every 3 to 4 months from the time of choroidal neovascularization diagnosis and encouraged to monitor their vision at home using home-based technologies where available, to provide the best opportunity for early detection