Is a virtual clinic model a safe and effective way for assessing patients referred with suspiciously blurred optic discs? The blurred disc clinic

2020 ◽  
pp. 112067212097604
Author(s):  
Joanna M Jefferis ◽  
Nigel Griffith ◽  
Daniel Blackwell ◽  
Ruth Batty ◽  
Simon J Hickman ◽  
...  
Keyword(s):  
Optic Nerve ◽  
Optic Disc ◽  
Direct Contact ◽  
Visual Fields ◽  
Referral Letter ◽  
Face To Face ◽  
The Face ◽  
Optic Discs ◽  
Eye Clinic ◽  
Virtual Clinic

Background: There are increasing numbers of referrals to ophthalmology departments due to blurred optic disc margins. In light of this and the COVID-19 pandemic we aimed to assess whether these patients could be safely assessed without direct contact between the clinician and patient. Methods: We retrospectively reviewed the records of consecutive patients seen in our ‘blurred disc clinic’ between August 2018 and October 2019. We then presented anonymous information from their referral letter, their visual fields and optic nerve images to two consultant neuro-ophthalmologists blinded to the outcome of the face-to-face consultation. In the simulated virtual clinic, the two consultants were asked to choose an outcome for each patient from discharge, investigate or bring in for a face-to-face assessment. Results: Out of 133 patients seen in the blurred disc clinic, six (4.5%) were found to have papilloedema. All six were identified by both neuro-ophthalmologists as needing a face-to-face clinic consultation from the simulated virtual clinic. One hundred and twenty (90%) patients were discharged from the face-to-face clinic at the first consultation. The two neuro-ophthalmologists chose to discharge 114 (95%) and 99 (83%) of these respectively from the simulated virtual clinic. The virtual clinic would have potentially missed serious pathology in only one patient who had normal optic discs but reported diplopia at the previous face-to-face consultation. Conclusions: A virtual clinic model is an effective way of screening for papilloedema in patients referred to the eye clinic with suspicious optic discs. Unrelated or incidental pathology may be missed in a virtual clinic.

Inherited or Congenital Optic Nerve Diseases

Visual Fields ◽  
2010 ◽  
Author(s):  
Peter A. Quiros ◽  
Alfredo A. Sadun
Keyword(s):  
Optic Nerve ◽  
Optic Disc ◽  
Case Reports ◽  
Visual Fields ◽  
Maternal Diabetes ◽  
Disc Center ◽  
Double Ring ◽  
Optic Nerve Diseases ◽  
Disc Size ◽  
Optic Disc Anomaly

In this chapter, we discuss inherited/congenital optic nerve diseases and their related visual fields defects. It is important for the ophthalmologist to establish, on the basis of the visual fields defect whether the optic nerve is involved and, if so, whether this is at the level of the optic disc or further back. In addition, the visual fields defect can help establish whether the etiology is acquired or congenital. If the former is the case, then the visual fields defect may reveal an insult that is rapidly progressive and hence requires immediate and aggressive management. The diseases are divided into the categories of congenital optic disc anomalies and heredodegenerative optic atrophies. Congenital optic disc anomalies include aplasias, dysplasias (hyperplasia and hypoplasia), optic nerve colobomas and pits, anomalous disc elevations: pseudopapilledema with or without hyaline bodies (drusen), and tilted disc and crescents. Absence of the optic disc (aplasia) is extremely rare and only a few case reports have been published in the literature. Optic disc size varies and may be larger (hyperplasia) or smaller (hypoplasia) than normal. Hyperplasia is much less common than hypoplasia and is usually related to ametropias. Optic nerve hypoplasia (ONH) may be unilateral or bilateral and isolated or associated with different syndromes. It may be associated with good or poor visual prognosis. It is the most common congenital optic disc anomaly encountered in pediatric ophthalmic practice. When the nerve head is slightly or segmentally reduced, especially in the presence of normal visual acuity, the diagnosis is based on comparison of disc photographs or calculation of the ratio of the disc center-to-fovea distance to disc diameter. Usually this ratio is increased in hypoplasia and, if higher than 3.0, is almost diagnostic. Sometimes the hypoplastic disc is surrounded by a ring of sclera and a ring of hyperpigmentation, described as “double-ring sign”. Maternal diabetes and use of teratogenic agents such as phenytoin, alcohol, quinine, and cocaine may be associated with ONH.

Is the Blind Spot Enlarged in Early Glaucoma?

1998 ◽  
Vol 8 (1) ◽  
pp. 28-32 ◽  
Author(s):  
J.H. Meyer ◽  
M. Guhlmann ◽  
J. Funk
Keyword(s):  
Optic Disc ◽  
Visual Fields ◽  
Stimulus Presentation ◽  
Light Sensitivity ◽  
Blind Spot ◽  
Control Group ◽  
Horizontal Meridian ◽  
Early Glaucoma ◽  
Disc Center ◽  
Optic Discs

Purpose We investigated whether the blind spot is larger in early “preperimetric” glaucoma with already deeply excavated optic discs than in normal persons. Methods We examined eight eyes of five patients with definite glaucomatous optic disc cupping but normal visual fields. Ten eyes of five normal healthy volunteers, with normal central excavation, served as controls. With SLO-perimetry we measured the differential light sensitivity 0.5-1.0° outside the disc margins, “within” the center (Goldmann V stimulus) and along the horizontal meridian of the optic discs. Optic disc topography was documented with the Heidelberg Retina Tomograph (HRT). Results Differential light sensitivities adjacent to the optic discs did not differ in the two groups (normal 8.3dB, early glaucoma 8.4dB). Goldmann IV stimuli presented on the horizontal meridian of optic discs with glaucomatous cupping were seen up to 0.7° centrally (i.e., towards the center) of the disc margin. In the control group this distance was significantly greater (1.3°). The light differential thresholds with stimulus presentation in the disc center (Goldmann V) were significantly higher in the glaucoma group (0±2.8dB) than in the normal controls (6.6±1.3dB), though disc size was the same in both groups. Conclusions Blind spots of normal discs seem to be smaller than those of deeply excavated discs in eyes with early glaucoma, possibly because there is more light scattering by the normal disc surface towards the adjacent functioning retina.

scholarly journals Historical aspects and current views of the etiopathogenesis and clinical manifestations of optic nerve pits

2022 ◽  
Vol 14 (4) ◽  
pp. 158-163
Author(s):  
E. V. Muskatina ◽  
D. Yu. Samsonov ◽  
S. I. Zhukova ◽  
А. G. Shchuko
Keyword(s):  
Optic Nerve ◽  
Optic Disc ◽  
Clinical Manifestations ◽  
Diagnostic Methods ◽  
Processing Technologies ◽  
Functional Changes ◽  
Non Invasive ◽  
Digital Scanning ◽  
Optic Discs

Optic nerve pits are a mono- or bilateral congenital anomaly represented by optic disc depressions of various sizes. In half of the cases, the pits are complicated by edema, central retinal detachment and retinoschisis, and cause visual function decrease. Visual acuity losses can be either insignificant or pronounced. Optic discs pits have been investigated massively over the last century and a half, but their etiology is still underresearched. In recent years, however, due to the development of digital scanning and data processing technologies and the emergence of non-invasive highly informative diagnostic methods, it has become possible to reveal structural and functional changes of the optic disc in vivo, in addition to the traditional detection of histological changes in cadaveric eyes.

scholarly journals The coloboma of the choroid simulating optic nerve duplication

2013 ◽  
Vol 6 (2) ◽  
pp. 67-74
Author(s):  
Yuriy Sergeyevich Astakhov ◽  
Yevgeniy Vladimirovich Butin ◽  
Nataliya Vladimirovna Morozova ◽  
Vitaliy Olegovich Sokolov ◽  
Svetlana Sergeevna Florentseva
Keyword(s):  
Optic Nerve ◽  
Visual Field ◽  
Optic Disc ◽  
Radiographic Analysis ◽  
Chorioretinal Atrophy ◽  
Adjoining Area ◽  
Retinal Artery ◽  
Work Up ◽  
Optic Discs ◽  
Blind Spots

In the article, a coloboma of the choroid is described simulating optic disc duplicaton as well as modern possibilities of instrumental work-up methods, which allowed to make a diagnosis. A coloboma (from the Greek koloboma, meaning defect) — is a defect of lid tissues, iris, choroid or optic nerve. A coloboma may be сongenital or acquired. A typical coloboma of the choroid is localized in the lower part of the eye fundus. At times, it comes down to the optic disc, and sometimes involves it as well. The white color of the defect is due to the show-through of the sclera, because the choroid here is completely absent. Corresponding to the coloboma of the choroid, the retina is hypoplastic or absent at times. An optic disc duplication — at this anomaly there are two optic discs on the eye fundus. Sometimes, both may be phtitical and hypoplastic, but more often one of them is hypoplastic, and the second one is performing its function. A true optic disc duplication comes out of the optic nerve partition into 2 or more fascicles. The duplicated optic nerve is pointed out by two optic foramens in one orbit by radiographic analysis, two blind spots in the visual field of one eye, simultaneous central retinal artery pulsation on both optic discs. Ultrasonic B-scanning or OCT and MRI may confirm the existence of a true optic nerve and optic disc duplication. A pseudo-duplication of the optic disc is also very rare and represents a well delineated defect, close to the normal optic disc and simulating an ancillary optic disc with an adjoining area of chorioretinal atrophy.

Note on Optic Nerve Atrophy preceding the Mental Symptoms of General Paralysis of the Insane

1889 ◽  
Vol 35 (151) ◽  
pp. 389-391 ◽  
Author(s):  
Joseph Wiglesworth
Keyword(s):  
Optic Nerve ◽  
Optic Disc ◽  
Optic Atrophy ◽  
Optic Nerve Atrophy ◽  
Normal Appearance ◽  
General Paralysis ◽  
Mental Symptoms ◽  
The Subject ◽  
Optic Discs ◽  
Fundus Oculi

In a communication on the subject of the condition of the fundus oculi in insane individuals,* undertaken in conjunction with my friend Mr. Bickerton, we described the optic disc changes met with in a series of 66 cases of general paralysis. We showed that whilst in the majority of cases of this disease the fundus oculi presented a normal appearance, in a considerable minority changes in the direction of neuritis or atrophy were to be found, and that whilst optic atrophy was noted as a sequel of neuritis, it was also not unfrequently primary at the disc. In all the cases observed by us, however, the changes in the optic discs had developed after the mental symptoms had become apparent, although we quoted from Nettleship† a case in which optic nerve atrophy preceded the symptoms of this disease. Such cases as this latter are, in my experience, decidedly rare, and hence the following appears worthy of being placed on record:—

Supporting the Use of Rudimentary Vocalizations

2014 ◽  
Vol 23 (3) ◽  
pp. 132-139 ◽  
Author(s):  
Lauren Zubow ◽  
Richard Hurtig
Keyword(s):  
Rett Syndrome ◽  
Visual Cues ◽  
Acoustic Analysis ◽  
Eye Gaze ◽  
Research Question ◽  
Primary Research ◽  
Multiple Modalities ◽  
Face To Face ◽  
Perceptual Judgments ◽  
The Face

Children with Rett Syndrome (RS) are reported to use multiple modalities to communicate although their intentionality is often questioned (Bartolotta, Zipp, Simpkins, & Glazewski, 2011; Hetzroni & Rubin, 2006; Sigafoos et al., 2000; Sigafoos, Woodyatt, Tuckeer, Roberts-Pennell, & Pittendreigh, 2000). This paper will present results of a study analyzing the unconventional vocalizations of a child with RS. The primary research question addresses the ability of familiar and unfamiliar listeners to interpret unconventional vocalizations as “yes” or “no” responses. This paper will also address the acoustic analysis and perceptual judgments of these vocalizations. Pre-recorded isolated vocalizations of “yes” and “no” were presented to 5 listeners (mother, father, 1 unfamiliar, and 2 familiar clinicians) and the listeners were asked to rate the vocalizations as either “yes” or “no.” The ratings were compared to the original identification made by the child's mother during the face-to-face interaction from which the samples were drawn. Findings of this study suggest, in this case, the child's vocalizations were intentional and could be interpreted by familiar and unfamiliar listeners as either “yes” or “no” without contextual or visual cues. The results suggest that communication partners should be trained to attend to eye-gaze and vocalizations to ensure the child's intended choice is accurately understood.

Antecedent Factors to Recommendation Intention on the Face-to-Face Job Consulting

2013 ◽  
Vol 14 (3) ◽  
pp. 115-133
Author(s):  
조현 ◽  
Jaeshin Park ◽  
ki-jin jang
Keyword(s):  
Face To Face ◽  
The Face ◽  
Recommendation Intention

Student Perceptions of Face-to-Face and Online Discussions: The Advantage Goes To . . .

2008 ◽  
Vol 11 (4) ◽  
Author(s):  
Katrina A. Meyer
Keyword(s):  
Higher Education ◽  
Affirmative Action ◽  
Student Perceptions ◽  
Online Discussions ◽  
Political Tolerance ◽  
Self Assessment ◽  
Face To Face ◽  
The Face ◽  
Online Setting ◽  
And Gender

Thirteen students in a graduate-level course on Historical and Policy Perspectives in Higher Education held face-to-face and online discussions on five controversial topics: Diversity, Academic Freedom, Political Tolerance, Affirmative Action, and Gender. Students read materials on each topic and generated questions for discussion that were categorized by Bloom’s taxonomy so that the level of questions in the two discussion settings would be closely parallel. Upon completion of each discussion, they answered questions that addressed depth and length of the discussion, ability to remember, and a self-assessment of how the student learned. Students’ assessments show a consistent preference for the face-to-face discussion but a small number of students preferred the online setting. However, what is perhaps more interesting is a minority of approximately one-third of the students who perceived no difference between the settings, or that the two settings were perhaps complementary.

The Hierophanic Facets of the Seraphic Hymns

Trictrac ◽  
2018 ◽  
Vol 10 ◽  
Author(s):  
Petru Adrian Danciu
Keyword(s):  
Mutual Recognition ◽  
The Other ◽  
Human Being ◽  
Material World ◽  
Face To Face ◽  
The People ◽  
Musical History ◽  
The Face ◽  
The One

Starting from the cry of the seraphim in Isaiahʹ s prophecy, this article aims to follow the rhythm of the sacred harmony, transcending the symbols of the angelic world and of the divine names, to get to the face to face meeting between man and God, just as the seraphim, reflecting their existence, stand face to face. The finality of the sacred harmony is that, during the search for God inside the human being, He reveals Himself, which is the reason for the affirmation of “I Am that I Am.” Through its hypnotic cyclicality, the profane temporality has its own musicality. Its purpose is to incubate the unsuspected potencies of the beings “caught” in the material world. Due to the fact that it belongs to the aeonic time, the divine music will exceed in harmony the mechanical musicality of profane time, dilating and temporarily cancelling it. Isaiah is witness to such revelation offering access to the heavenly concert. He is witness to divine harmonies produced by two divine singers, whose musical history is presented in our article. The seraphim accompanied the chosen people after their exodus from Egypt. The cultic use of the trumpet is related to the characteristics and behaviour of the seraphim. The seraphic music does not belong to the Creator, but its lyrics speak about the presence of the Creator in two realities, a spiritual and a material one. Only the transcendence of the divine names that are sung/cried affirms a unique reality: God. The chant-cry is a divine invocation with a double aim. On the one hand, the angels and the people affirm God’s presence and call His name and, on the other, the Creator affirms His presence through the angels or in man, the one who is His image and His likeness. The divine music does not only create, it is also a means of communion, implementing the relation of man to God and, thus, God’s connection with man. It is a relation in which both filiation and paternity disappear inside the harmony of the mutual recognition produced by music, a reality much older than Adam’s language.

Agents of Practice at the Public Library’s Reference Desk

2013 ◽  
Author(s):  
Mary Cavanagh
Keyword(s):  
Public Libraries ◽  
Face To Face ◽  
Professional Boundaries ◽  
The Public ◽  
Reference Librarians ◽  
Practice Perspective ◽  
The Face ◽  
Reference Et

The face to face interactions of reference librarians and reference assistants are studied from a theoretical practice perspective. Rather than reinforcing professional boundaries, the results of this analysis support reference practice in public libraries as a highly relational activity where reference “expertise” retains a significant subjectivist, relational dimension.Les interventions en personne des bibliothèques de référence et des adjoints à la référence sont étudiées du point de vue de la pratique théorique. Plutôt que de renforcer les frontières interprofessionnelles, les résultats de cette analyse appuient l'idée que les pratiques de référence en milieu public sont des activités hautement relationnelles où l'expertise de la référence conserve une dimension subjectiviste et relationnelle. 

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