SMARTPHONE-BASED DILATED FUNDUS PHOTOGRAPHY AND NEAR VISUAL ACUITY TESTING AS INEXPENSIVE SCREENING TOOLS TO DETECT REFERRAL WARRANTED DIABETIC EYE DISEASE

AimTo assess the impact of deprivation on diabetic retinopathy presentation and related treatment interventions, as observed within the UK hospital eye service.MethodsThis is a multicentre, national diabetic retinopathy database study with anonymised data extraction across 22 centres from an electronic medical record system. The following were the inclusion criteria: all patients with diabetes and a recorded, structured diabetic retinopathy grade. The minimum data set included, for baseline, age and Index of Multiple Deprivation, based on residential postcode; and for all time points, visual acuity, ETDRS grading of retinopathy and maculopathy, and interventions (laser, intravitreal therapies and surgery). The main outcome measures were (1) visual acuity and binocular visual state, and (2) presence of sight-threatening complications and need for early treatment.Results79 775 patients met the inclusion criteria. Deprivation was associated with later presentation in patients with diabetic eye disease: the OR of being sight-impaired at entry into the hospital eye service (defined as 6/18 to better than 3/60 in the better seeing eye) was 1.29 (95% CI 1.20 to 1.39) for the most deprived decile vs 0.77 (95% CI 0.70 to 0.86) for the least deprived decile; the OR for being severely sight-impaired (3/60 or worse in the better seeing eye) was 1.17 (95% CI 0.90 to 1.55) for the most deprived decile vs 0.88 (95% CI 0.61 to 1.27) for the least deprived decile (reference=fifth decile in all cases). There is also variation in sight-threatening complications at presentation and treatment undertaken: the least deprived deciles had lower chance of having a tractional retinal detachment (OR=0.48 and 0.58 for deciles 9 and 10, 95% CI 0.24 to 0.90 and 0.29 to 1.09, respectively); in terms of accessing treatment, the rate of having a vitrectomy was lowest in the most deprived cohort (OR=0.34, 95% CI 0.19 to 0.58).ConclusionsThis large real-world study suggests that first presentation at a hospital eye clinic with visual loss or sight-threatening diabetic eye disease is associated with deprivation. These initial hospital visits represent the first opportunities to receive treatment and to formally engage with support services. Such patients are more likely to be sight-impaired or severely sight-impaired at presentation, and may need additional resources to engage with the hospital eye services over complex treatment schedules.

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Do Black and Asian individuals wait longer for treatment? A survival analysis investigating the effect of ethnicity on time-to-clinic and time-to-treatment for diabetic eye disease

Diabetologia ◽

10.1007/s00125-020-05364-5 ◽

2021 ◽

Author(s):

Varo Kirthi ◽

Kate I. Reed ◽

Ramith Gunawardena ◽

Komeil Alattar ◽

Catey Bunce ◽

...

Keyword(s):

Visual Acuity ◽

Survival Analysis ◽

Black People ◽

Vision Loss ◽

Eye Disease ◽

White People ◽

Time To Treatment ◽

Distance Visual Acuity ◽

Diabetic Eye Disease ◽

The Impact

Abstract Aims/hypothesis This study explored the impact of ethnicity on time-to-clinic, time-to-treatment and rates of vision loss in people referred to hospital with diabetic eye disease. Methods A survival analysis was performed on all referrals from an inner-city diabetic eye screening programme to a tertiary hospital eye service between 1 October 2013 and 31 December 2017. Exclusion criteria were failure to attend hospital, distance visual acuity in both eyes too low to quantify with the Early Treatment Diabetic Retinopathy Study (ETDRS) letter chart and treatment received prior to referral. Demographic and screening grade data were collected at the point of referral. Small-area statistics and census data were used to calculate indices of multiple deprivation. The main outcome measures were time taken from the date of referral for an individual to achieve the following: (1) attend the first hospital clinic appointment; (2) receive the first macular laser, intravitreal anti-vascular endothelial growth factor injection or pan-retinal photocoagulation treatment, in either eye; and (3) lose at least ten ETDRS letters of distance visual acuity, in either eye. Results Of 2062 referrals, 1676 individuals were included. Mean age (± SD) was 57.6 ± 14.7 years, with 52% male sex and 86% with type 2 diabetes. The ethnicity profile was 52% Black, 30% White, 10% Asian and 9% mixed/other, with similar disease severity at the time of referral. Time-to-clinic was significantly longer for Asian people than for Black people (p = 0.03) or White people (p = 0.001). Time-to-treatment was significantly longer for Black people than for White people (p = 0.02). Social deprivation did not significantly influence time-to-treatment. There were no significant differences in the rates of vision loss between ethnic groups. Conclusions/interpretation Black people wait longer for hospital eye treatment compared with their White counterparts. The reasons for this delay in treatment warrant further investigation. Graphical abstract

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A seven-year analysis of the role and impact of a free community eye clinic

BMC Medical Education ◽

10.1186/s12909-021-03026-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lucas W. Rowe ◽

Melanie Scheive ◽

Hanna L. Tso ◽

Patrick Wurster ◽

Nicholas E. Kalafatis ◽

...

Keyword(s):

Visual Acuity ◽

Insurance Coverage ◽

Visual Fields ◽

Retrospective Chart Review ◽

Fundus Photography ◽

Relative Value ◽

Student Volunteers ◽

Near Visual Acuity ◽

Referral Status ◽

Eye Clinic

Abstract Background The Indiana University Student Outreach Clinic (IUSOC) Eye Clinic is a monthly student-run eye clinic that provides free visual screening to the Near East Side community of Indianapolis, IN, USA. Screening includes assessments of visual acuity, intraocular pressure, peripheral visual fields, refraction, and non-mydriatic fundus photography. Methods This is a retrospective chart review of 875 patients seen at the IUSOC Eye Clinic from October 2013 to February 2020. Data on demographics, insurance coverage, ocular history, physical examination, suspected diagnosis, referral status, and glasses provided were collected and analyzed. Results 875 patients were seen at the IUSOC Eye Clinic from October 2013 to February 2020. 39.2% of the patients seen at the clinic reported being uninsured. 61.4% of patients were found to have visual acuity of 20/40 or worse, while 51.3% of patients were found to have a near visual acuity of 20/40 or worse. 20.3% of patients were referred to the local county hospital for further evaluation by an ophthalmologist, 14.4% of patients received free glasses prescriptions, and 27.9% of patients received free reading glasses. Common reasons for referral for further ophthalmology evaluation included glaucoma, decreased visual acuity, and diabetic retinopathy. An estimated value of services provided over the seven years of the clinic was 1271 relative value units. Conclusion The IUSOC Eye Clinic fills an important role in advancing ocular health and preventing irreversible blindness in an underserved Indianapolis community. Additionally, the clinic demonstrates an educational model for involving medical student volunteers.

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Advancing the Detection and Management of Diabetic Retinopathy with Ultra-widefield Retinal Imaging

US Ophthalmic Review ◽

10.17925/usor.2017.10.01.23 ◽

2017 ◽

Vol 10 (01) ◽

pp. 23 ◽

Cited By ~ 1

Author(s):

David M Brown ◽

Keyword(s):

Diabetic Retinopathy ◽

Wide Spectrum ◽

Retinal Imaging ◽

Standard Of Care ◽

Fundus Photography ◽

Eye Disease ◽

Retinal Images ◽

The Us ◽

Diabetic Eye Disease ◽

Underlying Mechanisms

The incidence of diabetes in the US population has increased more than fourfold over the last several decades and a high proportion of these patients manifest diabetic eye disease, including diabetic retinopathy (DR) and diabetic macular edema (DME). Ultra-widefield (UWF) retinal imaging has emerged as a valuable tool in the evolving standard of care for DR, providing essential visualization of ischemia and related pathology across the retina, particularly in the periphery, where these signs may appear earliest but may not be detected by conventional fundus photography. Multimodal UWF imaging has helped correlate changes in the periphery with DR progression, providing important guidance for treatment planning and facilitating improved understanding of the underlying mechanisms of disease. Rapid capture, immediate retrieval and efficient sharing of UWF retinal images support a wide spectrum of care settings—including teleophthalmology programs—and facilitate patient education.

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Preliminary results of visual acuity testing in an African elephant

PsycEXTRA Dataset ◽

10.1037/e536982012-742 ◽

1997 ◽

Author(s):

Melissa R. Shyan ◽

Jeff Peterson ◽

Barbara Milankow ◽

Robert H. I. Dale

Keyword(s):

Visual Acuity ◽

African Elephant ◽

Preliminary Results ◽

Visual Acuity Testing

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Diabetic Eye Disease Projected to Triple by 2050

Family Practice News ◽

10.1016/s0300-7073(07)70932-5 ◽

2007 ◽

Vol 37 (15) ◽

pp. 18

Author(s):

MIRIAM E. TUCKER

Keyword(s):

Eye Disease ◽

Diabetic Eye Disease

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Comparison of trifocal or hybrid multifocal-extended depth of focus intraocular lenses: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-86222-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yueyang Zhong ◽

Kai Wang ◽

Xiaoning Yu ◽

Xin Liu ◽

Ke Yao

Keyword(s):

Systematic Review ◽

Visual Acuity ◽

Meta Analysis ◽

Visual Quality ◽

Intraocular Lenses ◽

Depth Of Focus ◽

Refractive Lens Exchange ◽

Extended Depth Of Focus ◽

Refractive Lens ◽

Near Visual Acuity

AbstractThis meta-analysis aimed to evaluate the clinical outcomes following implantation of trifocal intraocular lenses (IOLs) or a hybrid multifocal-extended depth of focus (EDOF) IOL in cataract or refractive lens exchange surgeries. We examined 13 comparative studies with bilateral implantation of trifocal (898 eyes) or hybrid multifocal-EDOF (624 eyes) IOLs published through 1 March 2020. Better uncorrected and corrected near visual acuity (VA) were observed in the trifocal group (MD: − 0.143, 95% CI: − 0.192 to − 0.010, P < 0.001 and MD: − 0.149, 95% CI: − 0.217 to − 0.082, P < 0.001, respectively), while the hybrid multifocal-EDOF group presented better uncorrected intermediate VA (MD: 0.055, 95% CI: 0.016 to 0.093, P = 0.005). Trifocal IOLs were more likely to achieve spectacle independence at near distance (RR: 1.103, 95% CI: 1.036 to 1.152, P = 0.002). The halo photic effect was generated more frequently by the trifocal IOLs (RR: 1.318, 95% CI: 1.025 to 1.696, P = 0.031). Contrast sensitivity and subjective visual quality yielded comparable results between groups. Trifocal IOLs demonstrated better performance at near distance but apparently led to more photic disturbances. Our findings provided the most up-to-date and comprehensive evidence by comparing the benefits of advanced IOLs in clinical practice.

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Diabetic eye disease

Handbook of Diabetes ◽

10.1002/9781118976074.ch15 ◽

2021 ◽

pp. 129-140

Keyword(s):

Eye Disease ◽

Diabetic Eye Disease

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Vision before and after scharioth macular lens implantation in patients with AMD: an electrophysiological study

Documenta Ophthalmologica ◽

10.1007/s10633-020-09814-8 ◽

2021 ◽

Author(s):

Jan Kremláček ◽

Jana Nekolová ◽

Markéta Středová ◽

Jana Langrová ◽

Jana Szanyi ◽

...

Keyword(s):

Visual Acuity ◽

Peripheral Vision ◽

Electrophysiological Study ◽

Age Related Macular Degeneration ◽

Peak Time ◽

Pattern Reversal ◽

Motion Onset ◽

Age Related ◽

Lens Implantation ◽

Near Visual Acuity

Abstract Background For patients with age-related macular degeneration (AMD), a special intraocular lens implantation partially compensates for the loss in the central part of the visual field. For six months, we evaluated changes in neurophysiological parameters in patients implanted with a “Scharioth macula lens” (SML; a center near high add + 10 D and peripheral plano carrier bifocal lens designed to be located between the iris and an artificial lens). Methods Fourteen patients (5 M, 9 F, 63–87 years) with dry AMD were examined prior to and at 3 days after, as well as 1, 2, and 6 months after, implantation using pattern-reversal, motion-onset, and cognitive evoked potentials, psychophysical tests evaluating distant and near visual acuity, and contrast sensitivity. Results Near visual acuity without an external aid was significantly better six months after implantation than before implantation (Jaeger table median (lower; upper quartile): 4 (1; 6) vs. 15 (13; 17)). Distant visual acuity was significantly altered between the pre- (0.7 (0.5; 0.8) logMAR) and last postimplantation visits (0.8 (0.7; 0.8) logMAR), which matched prolongation of the P100 peak time (147 (135; 151) ms vs. 161 (141; 166) ms) of 15 arc min pattern-reversal VEPs and N2 peak time (191.5 (186.5; 214.5) ms vs. 205 (187; 218) ms) of peripheral motion-onset VEPs. Conclusion SML implantation significantly improved near vision. We also observed a slight but significant decrease in distant and peripheral vision. The most efficient electrophysiological approach to test patients with SML was the peripheral motion-onset stimulation, which evoked repeatable and readable VEPs.

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