scholarly journals Assessment of Patients’ Confidence Regarding a New Triage Concept in a Medical Retina Clinic during the First COVID-19 Outbreak

2021 ◽  
Vol 18 (11) ◽  
pp. 5846
Author(s):  
Anahita Bajka ◽  
Maximilian Robert Justus Wiest ◽  
Timothy Hamann ◽  
Mario Damiano Toro ◽  
Sandrine Anne Zweifel
Keyword(s):  
Retrospective Study ◽  
Intravitreal Injection ◽  
Retinal Disease ◽  
Retinal Diseases ◽  
Access To Treatment ◽  
Patients Satisfaction ◽  
Medical Retina

Background: During the first COVID-19 pandemic outbreak, a new triage concept had to be implemented for patients with retinal diseases having a scheduled appointment at the medical retina clinic. In this study, we aimed to assess patients’ confidence in this triage concept and patients’ satisfaction regarding the received treatment during the outbreak. Methods: This retrospective study included all patients with a diagnosed retinal disease, triaged into three priority groups based on their condition’s urgency during lockdown. After restrictions were eased, a subset of previously triaged patients was interviewed to assess their confidence in the triage and their satisfaction regarding the received treatment during the pandemic. Results: In total, 743 patients were triaged during the lockdown. Over 80% received an urgent appointment (priority 1). Among all priority 1 patients, over 84% attended their appointment and 77% received an intravitreal injection (IVI), while 7% cancelled their appointment due to COVID-19. In post-lockdown interviews of 254 patients, 90% trusted the emergency regimen and received treatment. Conclusions: Our triage seemed to be useful in optimizing access to treatment for patients with retinal diseases. An excellent rating of patients’ confidence in the triage and satisfaction regarding the received treatment during the first COVID-19 outbreak could be achieved.

scholarly journals Development of a Fundus Image-Based Deep Learning Diagnostic Tool for Various Retinal Diseases

2021 ◽  
Vol 11 (5) ◽  
pp. 321
Author(s):  
Kyoung Min Kim ◽  
Tae-Young Heo ◽  
Aesul Kim ◽  
Joohee Kim ◽  
Kyu Jin Han ◽  
...  
Keyword(s):  
Network Models ◽  
Retinal Disease ◽  
Age Related Macular Degeneration ◽  
Diagnostic Tools ◽  
Retinal Images ◽  
Dense Layer ◽  
Retinal Diseases ◽  
Fundus Image ◽  
Neural Network Models ◽  
Age Related

Artificial intelligence (AI)-based diagnostic tools have been accepted in ophthalmology. The use of retinal images, such as fundus photographs, is a promising approach for the development of AI-based diagnostic platforms. Retinal pathologies usually occur in a broad spectrum of eye diseases, including neovascular or dry age-related macular degeneration, epiretinal membrane, rhegmatogenous retinal detachment, retinitis pigmentosa, macular hole, retinal vein occlusions, and diabetic retinopathy. Here, we report a fundus image-based AI model for differential diagnosis of retinal diseases. We classified retinal images with three convolutional neural network models: ResNet50, VGG19, and Inception v3. Furthermore, the performance of several dense (fully connected) layers was compared. The prediction accuracy for diagnosis of nine classes of eight retinal diseases and normal control was 87.42% in the ResNet50 model, which added a dense layer with 128 nodes. Furthermore, our AI tool augments ophthalmologist’s performance in the diagnosis of retinal disease. These results suggested that the fundus image-based AI tool is applicable for the medical diagnosis process of retinal diseases.

Comparison of Drug Distribution Between Intravitreal Injection and a Controlled–Release Implant in a Rabbit Eye

2000 ◽  
Author(s):  
Rupak K. Banerjee ◽  
Robert J. Lutz ◽  
Keyvan Keyhani ◽  
Robert L. Dedrick ◽  
Brian King ◽  
...  
Keyword(s):  
Controlled Release ◽  
Intravitreal Injection ◽  
Drug Concentration ◽  
Substantial Reduction ◽  
Drug Distribution ◽  
Retinal Disease ◽  
Systemic Circulation ◽  
Common Procedure ◽  
Release Device ◽  
Wide Range

Abstract Due to physiological barriers within the eye, which limit penetration of many drugs from the systemic circulation into the vitreous, the most common method of treating retinal disease is direct intravitreal injection. However, this common procedure may be inappropriate for a wide range of drugs as it may lead to highly variable concentrations potentially causing higher toxicity for tissues inside the eye and limiting therapeutic effect. A recent procedure is to use surgically implanted drug release device, called implant here, in the vitreous of the eye that allow controlled release of drug over a sustained period of time. For constant release of drug over 15 hours, a substantial reduction in peak drug concentration is predicted near the retina. When compared with the implant, a doubling of drug concentration would be expected for more than 3 hours near the retina for the intravitreal injection.

Medical retina

2014 ◽  
pp. 515-592 ◽  
Author(s):  
Alastair K.O. Denniston ◽  
Philip I. Murray
Keyword(s):  
Retinal Disease ◽  
Age Related Macular Degeneration ◽  
Cystoid Macular Oedema ◽  
Eye Disease ◽  
Anatomy And Physiology ◽  
Age Related ◽  
Clinical Presentations ◽  
Diabetic Eye Disease ◽  
Retinal Vascular Disease ◽  
Medical Retina

‘Medical retina’ provides the reader with a practical approach to the assessment and management of retinal disease. After outlining the relevant anatomy and physiology of this structure, the chapter addresses the key clinical presentations arising from retinal disease, notably age-related macular degeneration, diabetic eye disease, cystoid macular oedema, retinal vascular disease, and genetic retinal disease. Using a patient-centred approach the key clinical features, investigations and treatment (medical and surgical) are described for each condition.

scholarly journals Balancing the Photoreceptor Proteome: Proteostasis Network Therapeutics for Inherited Retinal Disease

Genes ◽  
2019 ◽  
Vol 10 (8) ◽  
pp. 557 ◽  
Author(s):  
Siebren Faber ◽  
Ronald Roepman
Keyword(s):  
Retinal Disease ◽  
Protein Accumulation ◽  
Retinal Diseases ◽  
High Turnover ◽  
Protein Balance ◽  
Light Sensing ◽  
Outer Segments ◽  
Inherited Retinal Disease ◽  
Tremendous Amount ◽  
Therapeutic Compounds

The light sensing outer segments of photoreceptors (PRs) are renewed every ten days due to their high photoactivity, especially of the cones during daytime vision. This demands a tremendous amount of energy, as well as a high turnover of their main biosynthetic compounds, membranes, and proteins. Therefore, a refined proteostasis network (PN), regulating the protein balance, is crucial for PR viability. In many inherited retinal diseases (IRDs) this balance is disrupted leading to protein accumulation in the inner segment and eventually the death of PRs. Various studies have been focusing on therapeutically targeting the different branches of the PR PN to restore the protein balance and ultimately to treat inherited blindness. This review first describes the different branches of the PN in detail. Subsequently, insights are provided on how therapeutic compounds directed against the different PN branches might slow down or even arrest the appalling, progressive blinding conditions. These insights are supported by findings of PN modulators in other research disciplines.

scholarly journals Neuroprotective Potential of Ginkgo biloba in Retinal Diseases

Planta Medica ◽  
2019 ◽  
Vol 85 (17) ◽  
pp. 1292-1303 ◽  
Author(s):  
Isabel Martínez-Solís ◽  
Nuria Acero ◽  
Francisco Bosch-Morell ◽  
Encarna Castillo ◽  
María Eugenia González-Rosende ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Ginkgo Biloba ◽  
Redox Homeostasis ◽  
Antioxidant Properties ◽  
Retinal Disease ◽  
Age Related Macular Degeneration ◽  
Retinal Diseases ◽  
Age Related ◽  
The Central Nervous System ◽  
Degenerative Processes

AbstractLike other tissues of the central nervous system, the retina is susceptible to damage by oxidative processes that result in several neurodegenerative disease such as age-related macular degeneration, diabetic retinopathy, glaucoma, ischaemic retinal disease, retinal disease produced by light oxidation, and detached retina, among other diseases. The use of antioxidant substances is a solution to some health problems caused by oxidative stress, because they regulate redox homeostasis and reduce oxidative stress. This is important for neurodegeneration linked to oxidation processes. In line with this, Ginkgo biloba is a medicinal plant with excellent antioxidant properties whose effects have been demonstrated in several degenerative processes, including retinal diseases associated with neurodegeneration. This review describes the current literature on the role of ginkgo in retinal diseases associated with neurodegeneration. The information leads to the conclusion that G. biloba extracts might be a good option to improve certain neurodegenerative retinal diseases, but more research is needed to determine the safety and efficacy of G. biloba in these retinal degenerative processes.

Off-label use of bevacizumab in the treatment of retinal disease: ethical implications

2019 ◽  
Vol 45 (10) ◽  
pp. 668-672
Author(s):  
Landon James Rohowetz
Keyword(s):  
Retinal Disease ◽  
World Health ◽  
Societal Implications ◽  
Retinal Diseases ◽  
Off Label Use ◽  
Off Label ◽  
Ethical Implications ◽  
Anti Vegf ◽  
The World ◽  
Label Use

Anti-vascular endothelial growth factor (anti-VEGF) therapy has revolutionised the treatment of a variety of ophthalmic conditions and has become the first-line therapy for a range of retinal diseases. Bevacizumab, a VEGF inhibitor first approved for the treatment of colorectal cancer, has been shown to be nearly or virtually as effective and safe as other anti-VEGF therapies in the treatment of certain retinal diseases but is not approved or registered by the Food and Drug Administration or European Medicines Agency. While other anti-VEGF options are approved and registered, they are generally more expensive and less accessible. Accordingly, despite its off-label status, bevacizumab is frequently used for a variety of disabling retinal diseases. Indeed, bevacizumab is included on the World Health Organization’s list of essential medicines. However, its use in some parts of the world remains restricted due to its off-label status. How, then, should healthcare authorities approach this situation? What are the ethical and societal implications of adhering to a standard and generally effective evaluation and approval system while restricting access to a potentially cost-saving therapy? In countries where its use is not restricted, how should providers approach off-label treatment with bevacizumab? By examining the evidence behind bevacizumab’s efficacy and safety and evaluating the individual and societal implications of off-label use and restriction, this paper illustrates the ethical factors providers and policy makers must consider in the off-label use of bevacizumab and ultimately argues for increased access to bevacizumab in the treatment of retinal disease.

scholarly journals Correction: Design, implementation, and evaluation of a nurse-led intravitreal injection programme for retinal diseases in Singapore

Eye ◽  
2020 ◽  
Vol 34 (11) ◽  
pp. 2151-2151
Author(s):  
Alvin Wei Jun Teo ◽  
Tyler Hyungtaek Rim ◽  
Chee Wai Wong ◽  
Andrew Shih Hsiang Tsai ◽  
Nazurah Loh ◽  
...  
Keyword(s):  
Intravitreal Injection ◽  
Retinal Diseases

The Blood–Retinal Barrier in Retinal Disease

2009 ◽  
Vol 03 (02) ◽  
pp. 105 ◽  
Author(s):  
José Cunha-Vaz ◽  
Keyword(s):  
Diabetic Retinopathy ◽  
Tight Junctions ◽  
Retinal Pigment ◽  
Water Flux ◽  
Retinal Disease ◽  
Retinal Pigment Epithelial Cells ◽  
Age Related Macular Degeneration ◽  
Retinal Diseases ◽  
Blood Retinal Barrier ◽  
Age Related

The blood–ocular barrier system is formed by two main barriers: the blood–aqueous barrier and the blood–retinal barrier (BRB). The BRB is particularly tight and restrictive and is a physiological barrier that regulates ion, protein and water flux into and out of the retina. The BRB consists of inner and outer components, the inner BRB being formed of tight junctions between retinal capillary endothelial cells and the outer BRB of tight junctions between retinal pigment epithelial cells. The BRB is essential to maintaining the eye as a privileged site and is essential for normal visual function. Alterations of the BRB play a crucial role in the development of retinal diseases. The two most frequent and relevant retinal diseases, diabetic retinopathy and age-related macular degeneration (AMD), are directly associated with alterations of the BRB. Diabetic retinopathy is initiated by an alteration of the inner BRB and neovascular AMD is a result of an alteration of the outer BRB. Treatment of retinal diseases must also deal with the BRB either by using its specific transport mechanisms or by circumventing it through intravitreal injections

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.

Involuntary admissions to a district mental health service – implications for a new mental treatment act

1993 ◽  
Vol 10 (3) ◽  
pp. 139-144 ◽  
Author(s):  
Teresa G Carey ◽  
John M Owens
Keyword(s):  
Mental Health ◽  
Retrospective Study ◽  
Mental Health Service ◽  
Civil Rights ◽  
Psychiatric Service ◽  
Case Note ◽  
Compulsory Admission ◽  
Access To Treatment ◽  
Mental Treatment ◽  
One Year

AbstractObjective: The aim of this study was to examine the working of the 1945 Irish Mental Treatment Act in relation to compulsory admission and detention and to establish issues that will need to be addressed in imminent new legislation. Method: A 3 year retrospective study was carried out on all compulsory admissions to the Cavan/Monaghan Psychiatric Service using case note material. The circumstances surrounding application for compulsory admission in one year of the study period were further investigated by delivery of a schedule to Relative-Applicants. Results: The study revealed rates of compulsory admission equivalent to other Irish regions but much higher than neighbouring jurisdictions. There was no evidence of deliberate abuse of the act. Indications emerged of excessive and inappropriate recourse to certification by some relatives and General Practitioners. Excessive length of detained stay and lack of specific procedures for informing patients of their rights were evident. Conclusions: A new Mental Treatment Act will need to place much greater emphasis on patients' civil rights while facilitating access to treatment.

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