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

2018 ◽  
Vol 102 (10) ◽  
pp. 1391-1395 ◽  
Author(s):  
Karsten Kortuem ◽  
Katrin Fasler ◽  
Amanda Charnley ◽  
Hussain Khambati ◽  
Sandro Fasolo ◽  
...  
Keyword(s):  
Fundus Photography ◽  
Retinal Diseases ◽  
First Line ◽  
Face To Face ◽  
Visual Acuity Testing ◽  
Timely Fashion ◽  
Promising Solution ◽  
Increasing Demand ◽  
Rapid Access Clinic ◽  
Medical Retina

BackgroundThe 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 fashionMethodsFirst 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.ResultsA 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%).ConclusionVMRC 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.

scholarly journals Impact of COVID-19 on management of urogynaecology patients: a rapid review of the literature

2021 ◽  
Author(s):  
Jemina Loganathan ◽  
◽  
Stergios K. Doumouchtsis
Keyword(s):  
Evidence Synthesis ◽  
Horizontal Transmission ◽  
Rapid Review ◽  
Review Of The Literature ◽  
First Line ◽  
Face To Face ◽  
Manual Search ◽  
Guidance Documents ◽  
Management Recommendations

Abstract Introduction and hypothesis The coronavirus (COVID-19) pandemic has impacted health systems worldwide. There is a continuing need for clinicians to adapt practice to facilitate timely provision of medical care, whilst minimising horizontal transmission. Guidance and recommendations are increasingly available, and this rapid review aimed to provide a timely evidence synthesis on the current recommendations surrounding urogynaecological care. Methods We performed a literature review using PubMed/Medline, Embase and Cochrane and a manual search of national and international societies for management recommendations for urogynaecological patients during the COVID-19 pandemic. Results Nine guidance documents and 17 articles, including 10 reviews, were included. Virtual clinics are recommended for new and follow-up patients, to assess and initiate treatment, as well as triage patients who require face-to-face appointments. Outpatient investigations such as urodynamics and cystoscopy for benign indications can be deferred. Prolapse and continence surgery should be suspended, except in specific circumstances such as procidentia with upper tract complications and failed pessaries. There is no evidence to support a particular route of surgery, but recommendations are made to minimise COVID-19 transmission. Conclusions Urogynaecological patients face particular challenges owing to inherent vulnerabilities of these populations. Behavioural and medical therapies should be recommended as first line options and initiated via virtual or remote clinics, which are integral to management during the COVID-19 pandemic. Expanding the availability and accessibility of technology will be increasingly required. The majority of outpatient and inpatient procedures can be deferred, but the longer-term effects of such practices are unclear.

scholarly journals Structural evaluation in inherited retinal diseases

2021 ◽  
pp. bjophthalmol-2021-319228
Author(s):  
Malena Daich Varela ◽  
Burak Esener ◽  
Shaima A Hashem ◽  
Thales Antonio Cabral de Guimaraes ◽  
Michalis Georgiou ◽  
...  
Keyword(s):  
Adaptive Optics ◽  
Fundus Autofluorescence ◽  
Standard Of Care ◽  
Laser Speckle ◽  
Fundus Photography ◽  
Laser Speckle Flowgraphy ◽  
Retinal Diseases ◽  
Autofluorescence Imaging ◽  
Structural Evaluation ◽  
Fundus Imaging

Ophthalmic genetics is a field that has been rapidly evolving over the last decade, mainly due to the flourishing of translational medicine for inherited retinal diseases (IRD). In this review, we will address the different methods by which retinal structure can be objectively and accurately assessed in IRD. We review standard-of-care imaging for these patients: colour fundus photography, fundus autofluorescence imaging and optical coherence tomography (OCT), as well as higher-resolution and/or newer technologies including OCT angiography, adaptive optics imaging, fundus imaging using a range of wavelengths, magnetic resonance imaging, laser speckle flowgraphy and retinal oximetry, illustrating their utility using paradigm genotypes with on-going therapeutic efforts/trials.

The relationship between T-CD4 recovery and HIV disclosure status among HIV-infected patients on first-line antiretroviral therapy at the Hospital for Tropical Diseases in Ho Chi Minh City

2021 ◽  
Vol 05 (02) ◽  
pp. 93-99
Author(s):  
Minh Nhat Dieu ◽  
◽  
Van Tam Vo ◽  
Dang Khoa Tran ◽  
Thi Kim Ngan Tran ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Disclosure ◽  
Ho Chi Minh City ◽  
Tropical Diseases ◽  
First Line ◽  
Face To Face ◽  
Disclosure Status ◽  
Record Review ◽  
The Relationship ◽  
Structured Questionnaire

Objective: Establishes a relationship between T-CD4 recovery and patient’s HIV disclosure status. Methods: Cross-section and clinical record review study on 151 HIV-infected patients who were 18 years old or above on first-line antiretroviral therapy (1) for 18 to 36 months at the Hospital for Tropical Diseases in Ho Chi Minh city (HCMC) in 2019. Participants are selected by convenient method. Research conducted face-to-face interviewing participants by structured questionnaire and collected data directly from each participant's respective medical record, including duration of ART, number of T-CD4 at the beginning of ART, number of current T-CD4. Results: The results showed that within patients who revealed HIV infection to other people, the patients who revealed to their brothers and sisters recovered T-CD4 were 1.45 times more effective (95% CI: 1.09 – 1.93) compared with patients who did not disclose to siblings (p = 0.010). Conclusion: Family members, especially siblings need to care and share so that HIV-infected patients can disclose their status. In particular, wife, husband or partners need to help and motivate patients more to make the patient's treatment better. Keywords: ART, T-CD4, recovery, HIV, disclosure.

scholarly journals Password Managers—It’s All about Trust and Transparency

2020 ◽  
Vol 12 (11) ◽  
pp. 189
Author(s):  
Fahad Alodhyani ◽  
George Theodorakopoulos ◽  
Philipp Reinecke
Keyword(s):  
User Interfaces ◽  
Interview Study ◽  
Questionnaire Study ◽  
First Line ◽  
Online Questionnaire ◽  
Usability Test ◽  
Promising Solution ◽  
Security Concerns

A password is considered to be the first line of defence in protecting online accounts, but there are problems when people handle their own passwords, for example, password reuse and difficult to memorize. Password managers appear to be a promising solution to help people handle their passwords. However, there is low adoption of password managers, even though they are widely available, and there are fewer studies on users of password managers. Therefore, the issues that cause people not to use password managers must be investigated and, more generally, what users think about them and the user interfaces of password managers. In this paper, we report three studies that we conducted: on user interfaces and the functions of three password managers; a usability test and an interview study; and an online questionnaire study about users and non-users of password managers, which also compares experts and non-experts regarding their use (or non-use) of password managers. Our findings show that usability is not a major problem, rather lack of trust and transparency are the main reasons for the low adoption of password managers. Users of password managers have trust and security concerns, while there are a few issues with the user interfaces and functions of password managers.

scholarly journals Prospective validation of a virtual clinic pathway in the management of choroidal naevi: the NAEVUS study Report no. 1: safety assessment

2020 ◽  
pp. bjophthalmol-2020-317371
Author(s):  
Lamis Al Harby ◽  
Zaria Ali ◽  
Azita Rajai ◽  
Stephen A Roberts ◽  
Tunde Peto ◽  
...  
Keyword(s):  
Gold Standard ◽  
Incidental Finding ◽  
Subretinal Fluid ◽  
Fundus Photography ◽  
Management Decision ◽  
Orange Pigment ◽  
Face To Face ◽  
Safe Management ◽  
Efficient Option ◽  
Virtual Clinic

BackgroundChoroidal naevi are a common incidental finding prompting specialist referrals to ocular oncology. Rarely, such lesions have sufficient suspicious features to diagnose a small melanoma. The aim of the study is to show that ‘virtual’ imaging-based pathways are a safe and efficient option to manage such referrals.MethodsA prospective cohort study at the Manchester Royal Eye Hospital and Moorfields Eye Hospital between June 2016 and July 2017 of the management decision of 400 patients reviewed by an ophthalmologist in a face-to-face consultation (gold standard) supported by fundus photography, optical coherence tomography, autofluorescence (AF) and B-mode ultrasound. The images were also read independently by blinded graders (non-medical) and blinded ophthalmologists, and a management decision was made based on image review alone (virtual pathway). The two pathways were compared for safety.ResultsThe agreement for management decisions between face-to-face and virtual pathways was 83.1% (non-medical) and 82.6% (medical). There were more over-referrals in the virtual pathway (non-medical 24.3%, medical 23.3% of gold standard discharge) and only two under-referrals (10.5% of gold standard referrals), both borderline cases with minimal clinical risk. The agreement for risk factors of growth (orange pigment, subretinal fluid, hyper-AF) ranged between 82.3% and 97.3%.ConclusionsWe prospectively validated a virtual clinic model for the safe management of choroidal naevi. Such a model of care is feasible with low rate of under-referral. An over-referral rate of almost 24% from the vitrual pathway needs to be factored into designing such pathways in conjunction with evidence on their cost-effectiveness.

A pilot trial of tele-ophthalmology for diagnosis of chronic blurred vision

2013 ◽  
Vol 19 (2) ◽  
pp. 65-69 ◽  
Author(s):  
Hwai Tan Johnson Choon ◽  
Ting Poh Eugenie Wei ◽  
Srinivasan Sanjay ◽  
Han Tim Tock
Keyword(s):  
Pilot Trial ◽  
Anterior Segment ◽  
Care Facility ◽  
Tertiary Hospital ◽  
Fundus Photography ◽  
Digital Information ◽  
Blurred Vision ◽  
Face To Face ◽  
Video Recordings ◽  
Experience Questionnaire

We evaluated the accuracy of tele-ophthalmology in diagnosing the major causes of chronic blurring of vision. Thirty consecutive patients attending a primary eye-care facility in Singapore (the Ang Mo Kio Polyclinic, AMKP) with the symptom of chronic blurred vision were recruited. An ophthalmic technician was trained to perform Snellen acuity; auto-refraction; intraocular pressure measurement; red-colour perimetry; video recordings of extraocular movement, cover tests and pupillary reactions; and anterior segment and fundus photography. Digital information was transmitted to a tertiary hospital in Singapore (the Tan Tock Seng Hospital) via a tele-ophthalmology system for teleconsultation with an ophthalmologist. The diagnoses were compared with face-to-face consultation by another ophthalmologist at the AMKP. A user experience questionnaire was administered at the end of the consultation. Using face-to-face consultation as the gold standard, tele-ophthalmology achieved 100% sensitivity and specificity in diagnosing media opacity (n = 29), maculopathy (n = 23) and keratopathy (n = 30) of any type; and 100% sensitivity and 92% specificity in diagnosing optic neuropathy of any type (n = 24). The majority of the patients (97%) were satisfied with the tele-ophthalmology workflow and consultation. The tele-ophthalmology system was able to detect causes of chronic blurred vision accurately. It has the potential to deliver high-accuracy diagnostic eye support to remote areas if suitably trained ophthalmic technicians are available.

scholarly journals A Multimodal Imaging–Based Deep Learning Model for Detecting Treatment-Requiring Retinal Vascular Diseases: Model Development and Validation Study

10.2196/28868 ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. e28868
Author(s):  
Eugene Yu-Chuan Kang ◽  
Ling Yeung ◽  
Yi-Lun Lee ◽  
Cheng-Hsiu Wu ◽  
Shu-Yen Peng ◽  
...  
Keyword(s):  
Deep Learning ◽  
Multimodal Imaging ◽  
Vascular Diseases ◽  
Learning Model ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Retinal Diseases ◽  
Ophthalmic Imaging ◽  
Retinal Fundus ◽  
Deep Learning Model

Background Retinal vascular diseases, including diabetic macular edema (DME), neovascular age-related macular degeneration (nAMD), myopic choroidal neovascularization (mCNV), and branch and central retinal vein occlusion (BRVO/CRVO), are considered vision-threatening eye diseases. However, accurate diagnosis depends on multimodal imaging and the expertise of retinal ophthalmologists. Objective The aim of this study was to develop a deep learning model to detect treatment-requiring retinal vascular diseases using multimodal imaging. Methods This retrospective study enrolled participants with multimodal ophthalmic imaging data from 3 hospitals in Taiwan from 2013 to 2019. Eye-related images were used, including those obtained through retinal fundus photography, optical coherence tomography (OCT), and fluorescein angiography with or without indocyanine green angiography (FA/ICGA). A deep learning model was constructed for detecting DME, nAMD, mCNV, BRVO, and CRVO and identifying treatment-requiring diseases. Model performance was evaluated and is presented as the area under the curve (AUC) for each receiver operating characteristic curve. Results A total of 2992 eyes of 2185 patients were studied, with 239, 1209, 1008, 211, 189, and 136 eyes in the control, DME, nAMD, mCNV, BRVO, and CRVO groups, respectively. Among them, 1898 eyes required treatment. The eyes were divided into training, validation, and testing groups in a 5:1:1 ratio. In total, 5117 retinal fundus photos, 9316 OCT images, and 20,922 FA/ICGA images were used. The AUCs for detecting mCNV, DME, nAMD, BRVO, and CRVO were 0.996, 0.995, 0.990, 0.959, and 0.988, respectively. The AUC for detecting treatment-requiring diseases was 0.969. From the heat maps, we observed that the model could identify retinal vascular diseases. Conclusions Our study developed a deep learning model to detect retinal diseases using multimodal ophthalmic imaging. Furthermore, the model demonstrated good performance in detecting treatment-requiring retinal diseases.

A pilot study of tele-ophthalmology outreach services to primary care

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 1-2 ◽  
Author(s):  
Dan Shanit ◽  
Tova Lifshitz ◽  
Ran Giladi ◽  
Yitzhak Peterburg
Keyword(s):  
Outpatient Clinic ◽  
Randomized Study ◽  
Local Population ◽  
Initial Assessment ◽  
Study Group ◽  
Retinal Diseases ◽  
Face To Face ◽  
Hospital Outpatient Clinic ◽  
Outreach Services ◽  
Health Centres

We have begun a randomized study of tele-ophthalmology. General practitioners in two participating health centres in the Negev region of Israel, serving a local population of 40,000, were invited to participate. The study group consisted of 50 consecutive patients attending the general eye outpatient clinic and 50 consecutive patients suffering from various retinal diseases attending a hospital outpatient clinic. The initial assessment was carried out via the tele-ophthalmology system. There was then a face-to-face re-examination of the same patients, in randomized order, by the same ophthalmologist on the same day, at an outpatient ophthalmology clinic.

Sparse Lp-Norm Based ICP for 3D Registration

2015 ◽  
Vol 742 ◽  
pp. 433-436
Author(s):  
Xiu Zhi Li ◽  
Bao Ling Qin ◽  
Huan Qiu ◽  
Song Min Jia
Keyword(s):  
3D Registration ◽  
Related Data ◽  
Digital Forensic ◽  
Use Of Resources ◽  
Efficiency And Effectiveness ◽  
Promising Solution ◽  
Digital Investigation ◽  
Increasing Demand ◽  
Network Forensic ◽  
Time Critical

In order to uncover truths to serve justice, case-related data collected from a digital investigation requires substantial resources to analyze, especially in time-critical situations. At present, however, digital forensics has not evolved to meet this ever-increasing demand. Digital forensic triage is a promising solution, as it is designed to maximize the use of resources according to a system of priorities, and hence the efficiency and effectiveness of forensic examinations can be increased. Nevertheless, the lack of concrete methods limits efforts to implement triage. This paper presents a practical approach that is designed to build a prioritizing solution. In this work a newprocess model is derived based on the presented approach, and it is particularly suited to scenarios where forensic examiners do not have enough time and resources to conduct a full examination and analysis. An example is described to demonstrate how this approach can be used to meet the requirements of network forensic investigations.

scholarly journals Novel splicing variant c. 208+2T>C in BBS5 segregates with Bardet–Biedl syndrome in an Iranian family by targeted exome sequencing

2019 ◽  
Vol 39 (3) ◽  
Author(s):  
Saber Imani ◽  
Jingliang Cheng ◽  
Jiewen Fu ◽  
Abdolkarim Mobasher-Jannat ◽  
Chunli Wei ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Fundus Photography ◽  
Biochemical Tests ◽  
Bardet Biedl Syndrome ◽  
Splicing Variant ◽  
Related Family ◽  
Iranian Family ◽  
Visual Acuity Testing ◽  
First Time ◽  
Splicing Site

AbstractBardet–Biedl syndrome (BBS) is a rare genetically heterogeneous ciliopathy which accompanies retinitis pigmentosa (RP). However, the BBS5 mutation remains unclear in Iranians with BBS. The purpose of study is to evaluate genetic analyses of a BBS Iranian family using targetted exome sequencing (TES). A male 11-year-old proband and three related family members were recruited. Biochemical tests, electrocardiography and visual acuity testing, such as funduscopic, fundus photography (FP), optical coherence tomography (OCT), and standard electroretinography, were conducted. Molecular analysis and high-throughput DNA sequence analysis were performed. The proband was diagnosed with possible BBS based on the presence of three primary features and two secondary features. The TES analysis of the proband with BBS resulted in the identification of a novel, homozygous splicing variant c. 208+2T>C of the BBS5 gene (NM_152384.2) in this Iranian BBS family. This variant was confirmed and was completely co-segregated with the disease in this family by Sanger sequencing. Thus, we report a novel, homozygous splicing site variant c.208+2T>C in the BBS5 gene for the first time in the Iranian family.

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