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Fundus Photographs (fundu + photograph)
Selected AbstractsA comparative evaluation of digital imaging, retinal photography and optometrist examination in screening for diabetic retinopathyDIABETIC MEDICINE, Issue 7 2003J. A. Olson Abstract Aims To compare the respective performances of digital retinal imaging, fundus photography and slit-lamp biomicroscopy performed by trained optometrists, in screening for diabetic retinopathy. To assess the potential contribution of automated digital image analysis to a screening programme. Methods A group of 586 patients recruited from a diabetic clinic underwent three or four mydriatic screening methods for retinal examination. The respective performances of digital imaging (n = 586; graded manually), colour slides (n = 586; graded manually), and slit-lamp examination by specially trained optometrists (n = 485), were evaluated against a reference standard of slit-lamp biomicroscopy by ophthalmologists with a special interest in medical retina. The performance of automated grading of the digital images by computer was also assessed. Results Slit-lamp examination by optometrists for referable diabetic retinopathy achieved a sensitivity of 73% (52,88) and a specificity of 90% (87,93). Using two-field imaging, manual grading of red-free digital images achieved a sensitivity of 93% (82,98) and a specificity of 87% (84,90), and for colour slides, a sensitivity of 96% (87,100) and a specificity of 89% (86,91). Almost identical results were achieved for both methods with single macular field imaging. Digital imaging had a lower technical failure rate (4.4% of patients) than colour slide photography (11.9%). Applying an automated grading protocol to the digital images detected any retinopathy, with a sensitivity of 83% (77,89) and a specificity of 71% (66,75) and diabetic macular oedema with a sensitivity of 76% (53,92) and a specificity of 85% (82,88). Conclusions Both manual grading methods produced similar results whether using a one- or two-field protocol. Technical failures rates, and hence need for recall, were lower with digital imaging. One-field grading of fundus photographs appeared to be as effective as two-field. The optometrists achieved the lowest sensitivities but reported no technical failures. Automated grading of retinal images can improve efficiency of resource utilization in diabetic retinopathy screening. Diabet. Med. 20, 528,534 (2003) [source] Comparison of optical coherence tomography and fundus photography for measuring the optic disc sizeOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 1 2006Aljoscha S. Neubauer Abstract Purpose:, To assess the agreement and repeatability of optic nerve head (ONH) size measurements by optical coherence tomography (OCT) as compared to conventional planimetry of fundus photographs in normal eyes. Methods:, For comparison with planimetry the absolute size of the ONH of 25 eyes from 25 normal subjects were measured by both OCT and digital fundus photography (Zeiss FF camera 450). Repeatability of automated Stratus OCT measurements were investigated by repeatedly measuring the optic disc in five normal subjects. Results:, Mean disc size was 1763 ± 186 vertically and 1632 ± 160 ,m horizontally on planimetry. On OCT, values of 1772 ± 317 ,m vertically (p = 0.82) and a significantly smaller horizontal diameter of 1492 ± 302 ,m (p = 0.04) were obtained. The 95% limits of agreement were (,546 ,m; +527 ,m) for vertical and (,502 ,m; +782 ,m) for horizontal planimetric compared to OCT measurements. In some cases large discrepancies existed. Repeatability of automatic measurements of the optic disc by OCT was moderately good with intra-class correlation coefficients (ICC) of 0.78 horizontally and 0.83 vertically. The coefficient of repeatability indicating instrument precision was 80 ,m for horizontal and 168 ,m for vertical measurements. Conclusions:, OCT can be used to determine optic disc margins in moderate agreement with planimetry in normal subjects. However, in some cases significant disagreement with photographic assessment may occur making manual inspection advisable. Automatic disc detection by OCT is moderately repeatable. [source] Retinal vascular findings and penile cavernosal artery blood flowBJU INTERNATIONAL, Issue 9 2003Y. Kawanishi Authors from Japan attempt to correlate retinal vascular changes with cavernosal arterial blood flow. They studied patients with erectile dysfunction, but excluded patients with previous pelvic surgery, pelvic injury or diabetes. They found that penile changes can be anticipated from retinal vascular changes seen on fundoscopy. OBJECTIVE To assess the correlation between retinal vascular findings and penile cavernosal arterial blood flow, as it is probable that systemic atherosclerotic vascular disease is important in male erectile dysfunction (ED), and being systemic, it might be possible to evaluate the extent of atherosclerosis from retinal vascular findings. PATIENTS AND METHODS The study included 75 patients with ED; any with a history of pelvic injury, pelvic surgery, or diabetes mellitus were excluded. All patients gave fully informed consent. Ocular fundus photographs were taken with an automatic-focus fundus camera under amydriatic conditions. Three ophthalmologists, unaware of the patients' detailed data, evaluated the photographs using Hyman's classification to evaluate retinal vascular findings. Blood flow in the penile cavernosal artery was measured with colour Doppler ultrasonography, and the peak systolic velocity used as a haemodynamic variable. Correlations among the peak systolic velocity, retinal vascular findings and vascular risk factors (including hypertension, age, cigarette smoking, and hyperlipidaemia) were investigated using multivariate analysis. RESULTS Of the 75 patients, 72 (96%) had both right and left retinal vascular images of sufficient quality for evaluation; 37 were classified as normal and 35 as Grade I, while no patient was Grade II. From a logistic regression multivariate analysis, the peak systolic velocity was the only significant factor correlating with retinal vascular findings, with an odds ratio of 3.34. In contrast, hypertension, age, cigarette smoking and hyperlipidaemia did not correlate significantly with the retinal vascular findings. Similarly, the retinal vascular finding was the only significant factor correlating with the peak systolic velocity of cavernosal blood flow (odds ratio 3.28) and again hypertension, age, cigarette smoking and hyperlipidaemia were not significant factors. CONCLUSIONS These findings support the assumption that penile erectile function is one of the diseases of atherosclerosis, and emerges nearly simultaneously with retinal vascular disease. It is possible to predict penile arterial conditions in patients with ED from their retinal vascular findings. Thus, amydriatic fundoscopy, a simple practical examination, may be helpful for primary physicians in diagnosing and treating ED. [source] Long-term study of vascular perfusion effects following arteriovenous sheathotomy for branch retinal vein occlusionACTA OPHTHALMOLOGICA, Issue 3 2010Mahiul M. K. Muqit Abstract. Purpose:, To evaluate the perfusion effects and long-term visual outcome of pars plana vitrectomy (PPV) combined with arteriovenous sheathotomy (AVS) with or without triamcinolone for nonischaemic branch retinal vein occlusion (NI-BRVO). Methods:, Prospective, interventional case series of eight patients with NI-BRVO and haemorrhagic macular oedema. Patients underwent PPV and AVS (n = 5), or PPV, AVS and intravitreal triamcinolone (IVT, n = 3). A masked grading technique assessed fundus photographs and fluorescein angiography (FFA) following surgery. Scanning laser ophthalmoscopy/optical coherence tomography (SLO/OCT) evaluated macular oedema and outer retinal architecture. Main outcomes examined included visual acuity (VA), retinal reperfusion, collateral vessel regression, vascular dilatation, cystoid macular oedema (CMO), and ocular neovascularization. Results:, Seven of eight patients underwent uncomplicated surgery, with increased intraretinal perfusion and reduced engorgement of distal retinal veins. The mean pre-logMAR VA was 0.8 (SD 0.17) and did not improve significantly after surgery (post-logMAR 0.6, SD 0.38; p = 0.11, paired t -test). SLO/OCT showed persistent CMO in four patients, and subfoveal thinning of the photoreceptor layer. Collateral vessels disappeared at the blockage site post-AVS in 7/8 eyes, and this was associated with improved retinal perfusion. Six of eight patients developed epiretinal membrane. No patients developed ocular neovascularization. The average follow-up was 34.5 months. Conclusions:, PPV with AVS is a safe procedure, and adjunctive IVT had no additional effects on vascular perfusion. Successful decompressive surgery was followed by disappearance of collateral vessels at the BRVO blockage site and was a clinical marker for intravascular reperfusion. Long-term epiretinal gliosis and subfoveal photoreceptor atrophy limited functional and visual recovery. [source] Visual fields and optic disc morphology in very low birthweight adolescents examined with magnetic resonance imaging of the brainACTA OPHTHALMOLOGICA, Issue 8 2009Kerstin Hellgren Abstract. Purpose:, We aimed to evaluate visual fields (VFs) and optic disc morphology in very low birthweight (VLBW) adolescents compared with age- and gender-matched controls, and to relate the findings to magnetic resonance imaging (MRI) results. Methods:, Fifty-nine VLBW adolescents and 55 age- and gender-matched controls with normal birthweight were examined. Visual fields were tested using computerized rarebit perimetry (RB). Optic nerve and retinal vessel morphology were evaluated by digital image analysis of fundus photographs. Brain MRI was conducted in the VLBW subjects. Results:, Ten of the 57 VLBW subjects (p = 0.022) had subnormal VF results defined as a mean hit rate below the fifth percentile of the controls (i.e. < 89%). All of these also had significantly lower mean hit rates (p = 0.039) in the inferior hemifield. Sixteen of 57 (28%) VLBW subjects had white matter damage of immaturity (WMDI) on MRI. Six of 15 subjects with WMDI (who underwent VF testing) also had subnormal RB results, compared with four of 39 with normal MRI findings (p = 0.02). The mean neural retinal rim area was 9% smaller (p = 0.018) in the VLBW group than in the control group. The VLBW adolescents had a significantly higher index for tortuosity of arterioles than the controls (p < 0.001). Conclusions:, In the present study, 18% of all VLBW adolescents and 40% of those with WMDI had subnormal RB VF findings. The VLBW group had increased arterial tortuosity and a somewhat smaller (9%) mean neural retinal rim area than the control group. Thus sequels to VLBW appear to persist in adolescence. [source] The role of optical coherence tomography in the detection of pituitary adenomaACTA OPHTHALMOLOGICA, Issue 7 2009Charlotta Johansson Abstract. Purpose:, To analyse retinal nerve fibre layer (RNFL) thickness in eyes with compression of the optic chiasm by a pituitary adenoma. RNFL thickness was analysed with optical coherence tomography (OCT) and compared to visual field measurements using high-pass resolution perimetry (HRP). Methods:, Sixteen eyes from eight patients with pituitary adenoma were studied. All had bitemporal visual field depression caused by compression of the optic chiasm. Patients were submitted to an ophthalmic examination more than 14 months after surgery (seven patients had undergone trans-sphenoidal and one trans-cranial adenomectomy). The examination included HRP, fundus photography and measurement of the peripapillar RNFL thickness using OCT. Results:, In spite of temporal visual field depression, not all eyes showed reduced RNFL thickness by OCT. This was also true for some eyes in which RNFL was judged to be reduced on fundus photographs. Contrary to our expectations, RNFL thickness in the nasal quadrant was normal in nine of the 16 eyes. Corresponding figures for the superior, inferior and temporal quadrants were eight, six and five, respectively. The overall RNFL thickness, as measured by OCT, did not correlate well with neural capacity, which is an index of remaining retino-cortical neural channels in HRP. Conclusion:, RNFL thickness as measured with OCT was reduced in most, but not all, eyes with temporal field depression caused by chiasmal compression. The pattern of RNFL loss did not correlate well with the visual field defect. Sensitivity of RNFL thickness measurement in OCT was low. The method has limited value in the diagnosis of pituitary tumour compression. [source] Automated quality evaluation of digital fundus photographsACTA OPHTHALMOLOGICA, Issue 6 2009Herman Bartling Abstract. Purpose:, Retinal images acquired by means of digital photography are often used for evaluation and documentation of the ocular fundus, especially in patients with diabetes, glaucoma or age-related macular degeneration. The clinical usefulness of an image is highly dependent on its quality. We set out to develop and evaluate an automatic method of evaluating the quality of digital fundus photographs. Methods:, A method for making a numerical quantification of image sharpness and illumination was developed using MatlabÔ image analysis functions. Based on their sharpness and illumination measures, 1000 fundus photographs, randomly selected from a clinical database, were assigned to four predefined quality groups (not acceptable, acceptable, good, very good). Six independent observers, comprising three experienced ophthalmologists and three ophthalmic nurses with extensive experience in fundus image acquisition, classified a selection of 100 of these images into the corresponding quality groups. Results:, Automatic quality evaluation was more sensitive than evaluation by human observers in terms of ability to discriminate between good and very good images. The median concordance between the six human observers and the automatic evaluation was substantial (kappa = 0.64). Conclusions:, The proposed method provides an objective quality assessment of digital fundus photographs which agrees well with evaluations made by qualified human observers and which may be useful in clinical practice. [source] Segmentation of FD-OCT images shows selective loss of inner retinal layers in patients with DM and no or early DRACTA OPHTHALMOLOGICA, Issue 2009FD VERBRAAK Purpose Determine whether diabetes differentially affects specific retinal layers by comparing the thickness of six retinal layers in diabetic patients with no or minimal diabetic retinopathy (DR) to age- and gender-matched normal controls. Methods Forty-four patients with type 1 diabetes and no or minimal DR underwent full ophthalmic examination, stereoscopic fundus photographs and spectral domain optical coherence tomography (OCT). Following automated segmentation of intraretinal layers of the OCT images, mean thickness was calculated for 6 individual layers of the retina in the fovea, the pericentral area and the peripheral area of the central macula and compared to an age- and gender-matched control group. Results In type 1 diabetic patients with minimal DR, the retinal nerve fiber layer (p=0.00) and the ganglion cell/inner plexiform layer (p=0.02) were significantly thinner compared to age- and gender-matched controls. No other layers showed a significant difference. Conclusion Thinning of the total retina in diabetic patients with minimal DR relative to normal controls is due to a selective thinning of inner retinal layers and supports the concept that early DR includes a neuro-degenerative component. [source] Prevalence of optic disc drusen in an adult Chinese population: the Beijing Eye StudyACTA OPHTHALMOLOGICA, Issue 2 2009Qi Sheng You Abstract. Purpose:, This study aimed to determine the prevalence of optic disc drusen and their associations with ocular and general parameters. Methods:, The Beijing Eye Study included 4439 of 5324 subjects invited to participate (response rate 83.4%). All subjects were aged , 40 years. The present investigation involved 8594 (96.8%) eyes of 4324 (97.4%) subjects from whom readable fundus photographs of at least one eye were available. The main outcome parameter was the presence of optic disc drusen defined as round, whitish bodies. Results:, Optic disc drusen were detected in nine (0.1 ± 0.05%) eyes of eight subjects (five women). The prevalence rate was 0.2 ± 0.07% (95% confidence interval 0.07,0.33%) per subject. Optic disc drusen were significantly associated with small optic discs (p < 0.001). They were not statistically associated with age (p = 0.90), gender (p = 0.73), intraocular pressure (p = 0.97), refractive error (p = 0.71), visual field defects (p = 0.47) or corrected visual acuity (p = 0.84). Conclusions:, Optic disc drusen are present in about two in 1000 adult Chinese people in Northern China. The main associated factor is a small optic disc. [source] Measurement of optic disc parameters on digital fundus photographs: algorithm development and evaluationACTA OPHTHALMOLOGICA, Issue 8 2008Herman Bartling Abstract. Purpose:, To develop and evaluate a simple and rapid algorithm for optic disc measurements on digital fundus photographs, relying on the macula,disc centre distance as a reference when converting length expressed in pixels to metric distance. Methods:, Measurements were performed on fundus photographs from 68 normal subjects, acquired using five different cameras. The magnification factor and actual size in ,m of 1 pixel was known for only one camera. The measurements from this camera were compared to corresponding measurements from a confocal scanning laser ophthalmoscope. Results:, Using the described algorithm, no significant differences in mean disc or cup size were observed between the tested cameras, despite differences in magnification factor (range 0.5,2.5). There were no significant differences between disc and cup measurements obtained with the confocal scanning laser ophthalmoscope and those obtained with the described algorithm in the 20 subjects examined. Conclusion:, The algorithm described in the current study provided clinically relevant measurements of optic disc parameters. The final program can be used directly on the acquired images, with the examined subject still available for re-examination. [source] Longterm findings in peripapillary crescent formation in eyes with mild or moderate myopiaACTA OPHTHALMOLOGICA, Issue 6 2008Mitsuru Nakazawa Abstract. Purpose:, To describe early changes of optic disc deviation and peripapillary crescent formation in eyes with mild or moderate myopia. Methods:, We carried out a retrospective review of medical records and fundus photographs. We evaluated serial fundus photographs taken in 10 patients with mild or moderate myopia. We observed longterm changes in optic disc areas by creating video files using these photographs and Photoshop® and Windows Movie Maker® software. The distance between the fovea and the temporal edge of the optic disc was measured in each photograph and any gradual changes in distance between these in the same patient were regarded as representative of optic disc deviation. Correlations between optic disc deviation (0,34.5% disc diameter) and either progression of myopia (, 0.75 D to 6.25 D) or length of follow-up (21,98 months) were statistically examined. Results:, On video files, the optic disc appeared to gradually deviate towards the nasal side and the myopic crescent developed gradually in the temporal side of the optic disc in most myopic patients. A significant correlation was found between optic disc deviation and progression of myopia (r2 = 0.61, p < 0.0001), but no correlation was detected between disc deviation and follow-up period (r2 = 0.055, p = 0.33). As optic disc deviation progressed, the peripapillary crescent became larger. Conclusions:, The optic disc appears to deviate mostly nasally as myopia progresses and the peripapillary crescent forms as a result of optic disc deviation in eyes with mild or moderate myopia. [source] Macular abnormalities and the Rarebit Fovea TestACTA OPHTHALMOLOGICA, Issue 2007L MARTIN Purpose: To describe Rarebit Fovea Test (RFT) findings in healthy subjects with normal best corrected visual acuity (BCVA) and macular abnormalities, observed in fundus photographs Methods: Forty-two healthy subjects, mean age 40 years (SD 10), were recruited as controls in a previous study. Selection criteria were BCVA , 1.0, refractive error within +/- 6 D, no ophthalmic or systemic disease. Reported here are RFT and fundus photography findings, and retinal thickness measurement values using optical coherence tomography (Stratus OCT, Carl Zeiss Meditec Int.). Results: Fifteen of the 42 subjects had visible macular changes in the fundus photographs; 10 had drusen and 5 pigment epithelium defects. Mean RFT mean hit rate (MHR) was 99+/-2%. Two subjects had MHR 91% and 96%, respectively, i.e. below the pre-defined limit for normality (97%). The subject with a MHR of 91% had drusen, the one with 96% had normal fundus. OCT values were within normal limits in all subjects (center zone mean 212.41 ,m, SD 19.35, range 166-257, inner perifoveal zone mean 238.99 SD 13.34, range 258.3-308.5 and outer perifoveal zone 241.53 SD 11.54, range 218-267.8). In the subject with RFT MHR 91% corresponding values were 228 ,m, 288.5,m and 249.3 ,m and in the subject with RFT MHT 96% 211,m, 279.8,m and 231.8,m, respectively, well inside the normal range. Conclusions: The Rarebit Fovea Test may be useful for discriminating between age-related macular changes with and without detrimental effects on visual function. [source] Glycodelin: a novel serum anti-inflammatory marker in type 1 diabetic retinopathy during pregnancyACTA OPHTHALMOLOGICA, Issue 1 2007Sirpa Loukovaara Abstract. Purpose:, Inflammation may play a role in the development of diabetic retinopathy during pregnancy. Glycodelin is a glycoprotein whose secretion from the endometrial glands increases during pregnancy. Glycodelin has immunosuppressive properties thought to play a role in the protection of the fetoplacental unit. We studied the role of glycodelin in the development and progression of retinopathy in type 1 diabetes during pregnancy. Methods:, Retinopathy was graded from fundus photographs in 45 diabetes subjects and nine non-diabetes subjects prospectively during pregnancy. Serum glycodelin concentration was measured by an immunofluorometric assay. Results:, In women with diabetes with progression of retinopathy, serum glycodelin concentration was 263 ng/ml (range 116,505 ng/ml) during the first trimester, 61 ng/ml (range 30,106 ng/ml) during the second trimester, and 29 ng/ml (range 13,53 ng/ml) during the third trimester, compared with values of 595 ng/ml (range 376,870 ng/ml), 104 ng/ml (range 75,228 ng/ml) and 45 ng/ml (range 32,74 ng/ml), respectively, in diabetes subjects without progression (p = 0.005 between the groups). Low glycodelin concentration was associated with progression of diabetic retinopathy in multiple regression analysis. Serum glycodelin concentration was similar in women with and without diabetes throughout pregnancy (p = 0.63 by repeated measures anova). Conclusions:, Low glycodelin concentration is associated with progression of retinopathy in pregnant women with diabetes. A possible causal relationship between low glycodelin levels and progression of retinopathy may be mediated by the immunomodulatory properties of glycodelin. [source] Relationships between ocular dimensions and adult stature among participants in the Reykjavik Eye StudyACTA OPHTHALMOLOGICA, Issue 6 2005Thor Eysteinsson Abstract. Purpose:,To examine the relationships between adult stature, age and ocular dimensions in a large homogenous, white population. Methods:,We used the national population census for Reykjavik to select a random sample of adults aged 50 years or older. A total of 846 persons were examined. Scheimpflug images were used to measure anterior chamber depth. Ultrasound was used to measure axial length, lens thickness and vitreous chamber depth. An autorefracto-keratometer was used to measure autorefractive and keratometric values, including the radius of the corneal curvature. Stereo fundus photographs were taken of the optic disc and measurements of the disc diameters were made using computer software. Results:,Height correlated positively with axial length in the multivariate model (B = 0.020, 95% CI 0.006,0.034, p < 0.01). Both age and height showed significant correlations with vitreous chamber depth, where the correlation with age was negative (B = , 0.016, 95% CI , 0.006 to , 0.025, p < 0.005) and the correlation with height was positive (B = 0.019, 95% CI 0.005,0.034, p < 0.01). Height also showed a positive correlation with the radius of the corneal curvature (B = 0.008, 95% CI 0.004,0.011, p < 0.001). Anterior chamber depth had a negative correlation with age (B = , 0.013, 95% CI , 0.010 to , 0.016, p < 0.001), whereas lens thickness had a significant positive correlation with age (B = 0.019, 95% CI 0.016,0.023, p < 0.001). We found a significant negative correlation between axial length and refraction/spherical equivalent (r = , 0.595, p < 0.0001). Discussion:,Our results indicate that there is a significant relationship between height and several ocular dimensions in this adult population and confirms a negative correlation between axial length and refraction. [source] Characterization of vigabatrin-associated optic atrophyACTA OPHTHALMOLOGICA, Issue 5 2003Lars Frisén Abstract. Aims:,To report the discovery of a previously unknown form of optic atrophy associated with use of the anti-epileptic drug vigabatrin. Methods:,We conducted a retrospective analysis of digitally enhanced ocular fundus photographs, kinetic visual field maps and treatment parameters for 25 patients, who were selected to represent a large spectrum of visual field defects. Results:,In all, 21 patients (84%) evidenced subtle, diffuse atrophy of the retinal nerve fibre layer, in a pattern accessible to scoring. Atrophy scores correlated with visual field remains and cumulative vigabatrin doses. A pathophysiological model is proposed that involves the lengths of intraocular (unmyelinated) retinal ganglion cell axons. Conclusion:,Optic atrophy attests to the irreversible nature of vigabatrin's visual toxicity. Ocular fundus imaging should prove useful for objectively monitoring vigabatrin-treated subjects for visual toxicity. [source] Abnormal vessel morphology in boys born after intracytoplasmic sperm injectionACTA PAEDIATRICA, Issue 11 2008Margareta Hök Wikstrand Abstract Aim: Children born after intracytoplasmic sperm injection (ICSI) are at risk of preterm birth, low birth weight and perinatal morbidity which may predispose for diseases of the central nervous and vascular systems. Our aim was to investigate the ocular fundus morphology in children born after ICSI. Method: Children born after ICSI (n = 82) had ocular fundus photographs taken at the age of 5 years and results were compared with those of a control group (n = 203). The ocular fundus morphology with the central retinal vessels was evaluated by digital image analysis. Results: Children born after ICSI (n = 57) had abnormal retinal vascularization as evidenced by a lower number of vascular branching points compared with the control group (n = 181) (p = 0.0002). A gender difference was found whereby the ICSI boys (n = 35) had significantly fewer retinal branching points (median 24, range 19,29.5) compared with the control boys (median 27.5, range 20,37) (p < 0.0001). Conclusion: Our findings showed that ICSI boys have abnormal vessel morphology as demonstrated by a reduced number of central retinal branching points. The difference still remained after elimination of factors earlier shown to be associated with a low number of vascular branching points, i.e. low birth weight and preterm, suggesting other mechanisms responsible for the low number of vascular branching points. [source] | ||||||||||