Retinal Image Registration and Comparison for Clinical Decision Support

Background For eye diseases, such as glaucoma and age-related macular degeneration (ARMD), involved in long-term degeneration procedure, longitudinal comparison of retinal images is a common step for reliable diagnosis of these kinds of diseases. Aims To provide a retinal image registration approach for longitudinal retinal image alignment and comparison. Method Two image registration solutions were proposed for facing different image qualities of retinal images to make the registration methods more robust and feasible in a clinical application system. Results Thirty pairs of longitudinal retinal images were used for the registration test. The experiments showed both solutions provided good performance for the accurate image registrations with efficiency. Conclusion We proposed a set of retinal image registration solutions for longitudinal retinal image observation and comparison targeting a clinical application environment

Teleophthalmology for the elderly population: A review of the literature

Background: Ophthalmology is one of the most requested medical speciality services in the elderly population. Although numerous studies have shown the potentials of telemedicine for the provision of ophthalmology services, the extent of its usability in older adults and the aged population is not clear. The aim of this study was to investigate the characteristics and usability features of teleophthalmology for the elderly population. Method: We searched PubMed, Embase, Scopus and CINAHL for relevant studies since 2008. Forty-five papers met the eligibility criteria and included in this review. We used a multifaceted model to extract the data and analyze findings by cross-tabulation. Results: The majority of the reviewed papers included participants of 65 years of age or older. Most of the studies were conducted in the USA (38 %). Diabetic retinopathy, glaucoma, age-related macular degeneration and cataract were the most researched eye diseases, and among the imaging technologies, retinal photography had been used the most (72 %). The studies showed teleophthalmology can improve access to specialty care, reduce the number of unnecessary visits, alleviate overloads on treatment centers, and provide more comprehensive exams. It also made services cost-saving for stakeholders and cost-effective in rural areas. However, teleophthalmology was not cost-effective for patients above 80 and low-density population areas. Conclusion: Evidence is lacking for the usability and effectiveness of teleophthalmology for the elderly population. The findings suggest that primary care providers in collaboration with ophthalmologists could provide more effective eye care to elderly population. Appropriate training is also necessary for primary care doctors to manage and refer older patients in a timely manner. Diagnostic value and cost-effective imaging modalities which are the core of the teleophthalmology, can be enhanced by image processing techniques and artificial intelligence

Telemedicine-friendly, portable tonometers: An evaluation for intraocular pressure screening

Purpose: To evaluate the intraocular pressure (IOP) readings from two portable, telemedicine-friendly tonometers for suitability in glaucoma screening. Methods: 213 eyes of 107 consenting patients attending an eye clinic were tested with an I-care tonometer and a Pulsair-Easy Eye puff-air tonometer. Gold standard IOP was measured with a Goldmann applanation tonometer (GAT). Effect of central corneal thickness, anterior chamber depth and refractive errors on IOP measurements were also analysed. Results: The mean difference of IOP by GAT and both the portable tonometers was ± 2.2 mmHg. The analysis indicates minimal difference between IOP readings of both the portable tonometers. The mean difference between two consecutive readings by I-care was 0.01 mmHg. Using 21 mmHg as a threshold for suspected glaucoma, both the portable digital tonometers reported a sensitivity of 38% and specificity of \u3e95%. In the subjects studied, central corneal thickness had statistically significant influence on IOP measurements while refractive errors and anterior chamber depth had no significant influence on IOP measurements with any tonometry. Conclusion: The IOP readings by both portable tonometers are comparable and were within clinically acceptable range from GAT. These portable tonometers are useful tools for IOP screening. [ABSTRACT FROM AUTHOR

Current practice in the management of ocular toxoplasmosis

Background Ocular toxoplasmosis is common across all regions of the world. Understanding of the epidemiology and approach to diagnosis and treatment have evolved recently. In November 2020, an international group of uveitis-specialised ophthalmologists formed the International Ocular Toxoplasmosis Study Group to define current practice. Methods 192 Study Group members from 48 countries completed a 36-item survey on clinical features, use of investigations, indications for treatment, systemic and intravitreal treatment with antiparasitic drugs and corticosteroids, and approach to follow-up and preventive therapy. Results For 77.1% of members, unilateral retinochoroiditis adjacent to a pigmented scar accounted for over 60% of presentations, but diverse atypical presentations were also reported. Common complications included persistent vitreous opacities, epiretinal membrane, cataract, and ocular hypertension or glaucoma. Most members used clinical examination with (56.8%) or without (35.9%) serology to diagnose typical disease but relied on intraocular fluid testing-usually PCR-in atypical cases (68.8%). 66.1% of members treated all non-pregnant patients, while 33.9% treated selected patients. Oral trimethoprim-sulfamethoxazole was first-line therapy for 66.7% of members, and 60.9% had experience using intravitreal clindamycin. Corticosteroid drugs were administered systemically by 97.4%; 24.7% also injected corticosteroid intravitreally, almost always in combination with an antimicrobial drug (72.3%). The majority of members followed up all (60.4%) or selected (35.9%) patients after resolution of acute disease, and prophylaxis against recurrence with trimethoprim-sulfamethoxazole was prescribed to selected patients by 69.8%. Conclusion Our report presents a current management approach for ocular toxoplasmosis, as practised by a large international group of uveitis-specialised ophthalmologists

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo