The Experts below are selected from a list of 5745 Experts worldwide ranked by ideXlab platform
Xincheng Yao - One of the best experts on this subject based on the ideXlab platform.
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trans pars planar illumination enables a 200 ultra wide field pediatric Fundus camera for easy examination of the retina
Biomedical Optics Express, 2020Co-Authors: Devrim Toslak, Felix Y Chau, Muhammet Kazim Erol, Changgeng Liu, R Paul V Chan, Taeyoon Son, Xincheng YaoAbstract:This study is to test the feasibility of using trans-pars-planar illumination for ultra-wide field pediatric Fundus Photography. Fundus examination of the peripheral retina is essential for clinical management of pediatric eye diseases. However, current pediatric Fundus cameras with traditional trans-pupillary illumination provide a limited field of view (FOV), making it difficult to access the peripheral retina adequately for a comprehensive assessment of eye conditions. Here, we report the first demonstration of trans-pars-planar illumination in ultra-wide field pediatric Fundus Photography. For proof-of-concept validation, all off-the-shelf optical components were selected to construct a lab prototype pediatric camera (PedCam). By freeing the entire pupil for imaging purpose only, the trans-pars-planar illumination enables a 200° FOV PedCam, allowing easy visualization of both the central and peripheral retina up to the ora serrata. A low-cost, easy-to-use ultra-wide field PedCam provides a unique opportunity to foster affordable telemedicine in rural and underserved areas.
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contact free trans pars planar illumination enables snapshot Fundus camera for nonmydriatic wide field Photography
Scientific Reports, 2018Co-Authors: Benquan Wang, Devrim Toslak, R Paul V Chan, Minhaj Alam, Xincheng YaoAbstract:In conventional Fundus Photography, trans-pupillary illumination delivers illuminating light to the interior of the eye through the peripheral area of the pupil, and only the central part of the pupil can be used for collecting imaging light. Therefore, the field of view of conventional Fundus cameras is limited, and pupil dilation is required for evaluating the retinal periphery which is frequently affected by diabetic retinopathy (DR), retinopathy of prematurity (ROP), and other chorioretinal conditions. We report here a nonmydriatic wide field Fundus camera employing trans-pars-planar illumination which delivers illuminating light through the pars plana, an area outside of the pupil. Trans-pars-planar illumination frees the entire pupil for imaging purpose only, and thus wide field Fundus Photography can be readily achieved with less pupil dilation. For proof-of-concept testing, using all off-the-shelf components a prototype instrument that can achieve 90° Fundus view coverage in single-shot Fundus images, without the need of pharmacologic pupil dilation was demonstrated.
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near infrared light guided miniaturized indirect ophthalmoscopy for nonmydriatic wide field Fundus Photography
Optics Letters, 2018Co-Authors: Devrim Toslak, Changgeng Liu, Minhaj Alam, Xincheng YaoAbstract:A portable Fundus imager is essential for emerging telemedicine screening and point-of-care examination of eye diseases. However, existing portable Fundus cameras have limited field of view (FOV) and frequently require pupillary dilation. We report here a miniaturized indirect ophthalmoscopy-based nonmydriatic Fundus camera with a snapshot FOV up to 67° external angle, which corresponds to a 101° eye angle. The wide-field Fundus camera consists of a near-infrared light source (LS) for retinal guidance and a white LS for color retinal imaging. By incorporating digital image registration and glare elimination methods, a dual-image acquisition approach was used to achieve reflection artifact-free Fundus Photography.
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trans palpebral illumination an approach for wide angle Fundus Photography without the need for pupil dilation
Optics Letters, 2016Co-Authors: Devrim Toslak, Damber Thapa, Yanjun Chen, Muhammet Kazim Erol, R Paul V Chan, Xincheng YaoAbstract:It is technically difficult to construct wide-angle Fundus imaging devices due to the complexity of conventional transpupillary illumination and imaging mechanisms. We report here a new method, i.e., trans-palpebral illumination, for wide-angle Fundus Photography without the need for pupil dilation. By constructing a smartphone-based prototype imaging device, we demonstrated a 152° view in a single-shot image. The unique combination of low-cost smartphone design and automatic illumination optimization promises an affordable solution to conduct telemedicine assessment of eye diseases, which will improve access to eye care for patients in rural and underserved areas.
Devrim Toslak - One of the best experts on this subject based on the ideXlab platform.
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trans pars planar illumination enables a 200 ultra wide field pediatric Fundus camera for easy examination of the retina
Biomedical Optics Express, 2020Co-Authors: Devrim Toslak, Felix Y Chau, Muhammet Kazim Erol, Changgeng Liu, R Paul V Chan, Taeyoon Son, Xincheng YaoAbstract:This study is to test the feasibility of using trans-pars-planar illumination for ultra-wide field pediatric Fundus Photography. Fundus examination of the peripheral retina is essential for clinical management of pediatric eye diseases. However, current pediatric Fundus cameras with traditional trans-pupillary illumination provide a limited field of view (FOV), making it difficult to access the peripheral retina adequately for a comprehensive assessment of eye conditions. Here, we report the first demonstration of trans-pars-planar illumination in ultra-wide field pediatric Fundus Photography. For proof-of-concept validation, all off-the-shelf optical components were selected to construct a lab prototype pediatric camera (PedCam). By freeing the entire pupil for imaging purpose only, the trans-pars-planar illumination enables a 200° FOV PedCam, allowing easy visualization of both the central and peripheral retina up to the ora serrata. A low-cost, easy-to-use ultra-wide field PedCam provides a unique opportunity to foster affordable telemedicine in rural and underserved areas.
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contact free trans pars planar illumination enables snapshot Fundus camera for nonmydriatic wide field Photography
Scientific Reports, 2018Co-Authors: Benquan Wang, Devrim Toslak, R Paul V Chan, Minhaj Alam, Xincheng YaoAbstract:In conventional Fundus Photography, trans-pupillary illumination delivers illuminating light to the interior of the eye through the peripheral area of the pupil, and only the central part of the pupil can be used for collecting imaging light. Therefore, the field of view of conventional Fundus cameras is limited, and pupil dilation is required for evaluating the retinal periphery which is frequently affected by diabetic retinopathy (DR), retinopathy of prematurity (ROP), and other chorioretinal conditions. We report here a nonmydriatic wide field Fundus camera employing trans-pars-planar illumination which delivers illuminating light through the pars plana, an area outside of the pupil. Trans-pars-planar illumination frees the entire pupil for imaging purpose only, and thus wide field Fundus Photography can be readily achieved with less pupil dilation. For proof-of-concept testing, using all off-the-shelf components a prototype instrument that can achieve 90° Fundus view coverage in single-shot Fundus images, without the need of pharmacologic pupil dilation was demonstrated.
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near infrared light guided miniaturized indirect ophthalmoscopy for nonmydriatic wide field Fundus Photography
Optics Letters, 2018Co-Authors: Devrim Toslak, Changgeng Liu, Minhaj Alam, Xincheng YaoAbstract:A portable Fundus imager is essential for emerging telemedicine screening and point-of-care examination of eye diseases. However, existing portable Fundus cameras have limited field of view (FOV) and frequently require pupillary dilation. We report here a miniaturized indirect ophthalmoscopy-based nonmydriatic Fundus camera with a snapshot FOV up to 67° external angle, which corresponds to a 101° eye angle. The wide-field Fundus camera consists of a near-infrared light source (LS) for retinal guidance and a white LS for color retinal imaging. By incorporating digital image registration and glare elimination methods, a dual-image acquisition approach was used to achieve reflection artifact-free Fundus Photography.
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trans palpebral illumination an approach for wide angle Fundus Photography without the need for pupil dilation
Optics Letters, 2016Co-Authors: Devrim Toslak, Damber Thapa, Yanjun Chen, Muhammet Kazim Erol, R Paul V Chan, Xincheng YaoAbstract:It is technically difficult to construct wide-angle Fundus imaging devices due to the complexity of conventional transpupillary illumination and imaging mechanisms. We report here a new method, i.e., trans-palpebral illumination, for wide-angle Fundus Photography without the need for pupil dilation. By constructing a smartphone-based prototype imaging device, we demonstrated a 152° view in a single-shot image. The unique combination of low-cost smartphone design and automatic illumination optimization promises an affordable solution to conduct telemedicine assessment of eye diseases, which will improve access to eye care for patients in rural and underserved areas.
R Paul V Chan - One of the best experts on this subject based on the ideXlab platform.
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trans pars planar illumination enables a 200 ultra wide field pediatric Fundus camera for easy examination of the retina
Biomedical Optics Express, 2020Co-Authors: Devrim Toslak, Felix Y Chau, Muhammet Kazim Erol, Changgeng Liu, R Paul V Chan, Taeyoon Son, Xincheng YaoAbstract:This study is to test the feasibility of using trans-pars-planar illumination for ultra-wide field pediatric Fundus Photography. Fundus examination of the peripheral retina is essential for clinical management of pediatric eye diseases. However, current pediatric Fundus cameras with traditional trans-pupillary illumination provide a limited field of view (FOV), making it difficult to access the peripheral retina adequately for a comprehensive assessment of eye conditions. Here, we report the first demonstration of trans-pars-planar illumination in ultra-wide field pediatric Fundus Photography. For proof-of-concept validation, all off-the-shelf optical components were selected to construct a lab prototype pediatric camera (PedCam). By freeing the entire pupil for imaging purpose only, the trans-pars-planar illumination enables a 200° FOV PedCam, allowing easy visualization of both the central and peripheral retina up to the ora serrata. A low-cost, easy-to-use ultra-wide field PedCam provides a unique opportunity to foster affordable telemedicine in rural and underserved areas.
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contact free trans pars planar illumination enables snapshot Fundus camera for nonmydriatic wide field Photography
Scientific Reports, 2018Co-Authors: Benquan Wang, Devrim Toslak, R Paul V Chan, Minhaj Alam, Xincheng YaoAbstract:In conventional Fundus Photography, trans-pupillary illumination delivers illuminating light to the interior of the eye through the peripheral area of the pupil, and only the central part of the pupil can be used for collecting imaging light. Therefore, the field of view of conventional Fundus cameras is limited, and pupil dilation is required for evaluating the retinal periphery which is frequently affected by diabetic retinopathy (DR), retinopathy of prematurity (ROP), and other chorioretinal conditions. We report here a nonmydriatic wide field Fundus camera employing trans-pars-planar illumination which delivers illuminating light through the pars plana, an area outside of the pupil. Trans-pars-planar illumination frees the entire pupil for imaging purpose only, and thus wide field Fundus Photography can be readily achieved with less pupil dilation. For proof-of-concept testing, using all off-the-shelf components a prototype instrument that can achieve 90° Fundus view coverage in single-shot Fundus images, without the need of pharmacologic pupil dilation was demonstrated.
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trans palpebral illumination an approach for wide angle Fundus Photography without the need for pupil dilation
Optics Letters, 2016Co-Authors: Devrim Toslak, Damber Thapa, Yanjun Chen, Muhammet Kazim Erol, R Paul V Chan, Xincheng YaoAbstract:It is technically difficult to construct wide-angle Fundus imaging devices due to the complexity of conventional transpupillary illumination and imaging mechanisms. We report here a new method, i.e., trans-palpebral illumination, for wide-angle Fundus Photography without the need for pupil dilation. By constructing a smartphone-based prototype imaging device, we demonstrated a 152° view in a single-shot image. The unique combination of low-cost smartphone design and automatic illumination optimization promises an affordable solution to conduct telemedicine assessment of eye diseases, which will improve access to eye care for patients in rural and underserved areas.
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influence of fluorescein angiography on the diagnosis and management of retinopathy of prematurity
Ophthalmology, 2015Co-Authors: Michael A Klufas, Samir N Patel, Michael C Ryan, Mrinali P Gupta, Karyn Jonas, Susan Ostmo, Maria Ana Martinezcastellanos, Audina M Berrocal, Michael F Chiang, R Paul V ChanAbstract:Purpose To examine the influence of fluorescein angiography (FA) on the diagnosis and management of retinopathy of prematurity (ROP). Design Prospective cohort study. Participants Nine recognized ROP experts (3 pediatric ophthalmologists and 6 retina specialists) interpreted 32 sets (16 color Fundus photographs and 16 color Fundus photographs paired with the corresponding FA images) of wide-angle retinal images from infants with ROP. Methods All experts independently reviewed the 32 image sets on a secure website and provided a diagnosis and management plan for the case presented, first based on color Fundus photographs alone, and then based on color Fundus photographs and corresponding FA images. Main Outcome Measures Sensitivity and specificity of the ROP diagnosis (zone, stage, plus disease, and category, i.e., no ROP, mild ROP, type 2 ROP, and ROP requiring treatment) were calculated using a consensus reference standard diagnosis, determined from the diagnosis of the color Fundus photographs by 3 experienced readers in combination with the clinical diagnosis based on ophthalmoscopic examination. The κ statistic was used to analyze the average intergrader agreement among experts for the diagnosis of zone, stage, plus disease, and category. Results Addition of FA to color Fundus Photography resulted in a significant improvement in sensitivity for diagnosis of stage 3 or worse disease (39.8% vs. 74.1%; P = 0.008), type 2 or worse ROP (69.4% vs. 86.8%; P = 0.013), and pre-plus or worse disease (50.5 vs. 62.6%; P = 0.031). There was a nonsignificant trend toward improved sensitivity for diagnosis of ROP requiring treatment (22.2% vs. 40.3%; P = 0.063). Using the κ statistic, addition of FA to color Fundus Photography significantly improved intergrader agreement for diagnosis of ROP requiring treatment. Addition of FA to color Fundus Photography did not affect intergrader agreement significantly for the diagnosis of stage, zone, or plus disease. Conclusions Compared with color Fundus Photography alone, FA may improve the sensitivity of diagnosis of ROP by experts, particularly for stage 3 disease. In addition, intergrader agreement for diagnosis of ROP requiring treatment may improve with FA interpretation.
Nancy J. Newman - One of the best experts on this subject based on the ideXlab platform.
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feasibility of a nonmydriatic ocular Fundus camera in an outpatient neurology clinic
The Neurologist, 2020Co-Authors: Neha K Irani, Nancy J. Newman, Gregory J Esper, Samuel Bidot, Jason H Peragallo, Valérie BiousseAbstract:OBJECTIVE To determine the feasibility of nonmydriatic Fundus Photography in the neurology outpatient setting and to record frequency of clinically relevant Fundus findings. METHODS Over 5 weeks, Fundus photographs were obtained using a nonmydriatic Fundus camera in both eyes of adult patients attending our general neurology and headache clinics. A neurologist, who had received 15 minutes of training on the use of the camera, took the photographs. Quality of photographs was graded. Photographs were reviewed by 2 neuro-ophthalmologists. Treating neurologists completed a survey on the use of this technology in the neurology clinic. Feasibility parameters including ease, comfort, speed, quality, and clinical relevance of nonmydriatic Fundus Photography was assessed. RESULTS We obtained 505 Fundus photographs of 206 patients. Median time to completion of photographs per patient was 2.12 minutes. Mean rating for ease, comfort, and speed was 9.7 out of 10. Among these, 160 had normal and 44 had abnormal findings. In 114 of 206 patients, neurologists relied on photographs for ocular Fundus assessment. In the remaining 92 patients, 18 patients had abnormal photographs, of which neurologists missed the abnormality in 14 (78%). All neurologists preferred nonmydriatic Fundus Photography over direct ophthalmoscopy. CONCLUSIONS Using nonmydriatic Fundus Photography in an outpatient neurology clinic is feasible without disrupting patient flow or causing patient discomfort. Findings of optic nerve pallor, optic nerve swelling, or normal optic nerves were particularly relevant to these patients seen for headaches or demyelinating disease and helped inform immediate diagnosis and management.
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Fundus Photography vs ophthalmoscopy outcomes in the emergency department foto ed phase iii web based in service training of emergency providers
Neuro-Ophthalmology, 2018Co-Authors: Beau B. Bruce, Nancy J. Newman, David W Wright, Samuel Bidot, Rabih Hage, Lindsay Clough, Caroline Fajolesvasseneix, Mikhail Melomed, Matthew T Keadey, Valérie BiousseAbstract:We evaluated a web-based training aimed at improving the review of Fundus Photography by emergency providers. 587 patients were included, 12.6% with relevant abnormalities. Emergency providers spen...
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ophthalmoscopy in the 21st century the 2017 h houston merritt lecture
Neurology, 2017Co-Authors: Valérie Biousse, Beau B. Bruce, Nancy J. NewmanAbstract:Although the usefulness of viewing the ocular Fundus is well-recognized, ophthalmoscopy is infrequently and poorly performed by most nonophthalmologist physicians, including neurologists. Barriers to the practice of ophthalmoscopy by nonophthalmologists include not only the technical difficulty related to direct ophthalmoscopy, but also lack of adequate training and discouragement by preceptors. Recent studies have shown that digital retinal Fundus photographs with electronic transmission and remote interpretation of images by an ophthalmologist are an efficient and reliable way to allow examination of the ocular Fundus in patients with systemic disorders such as diabetes mellitus. Ocular Fundus photographs obtained without pharmacologic dilation of the pupil using nonmydriatic Fundus cameras could be of great value in emergency departments (EDs) and neurologic settings. The Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study showed that ED providers consistently failed to correctly identify relevant ocular Funduscopic findings using the direct ophthalmoscope, and that nonmydriatic Fundus Photography was an effective alternate way of providing access to the ocular Fundus in the ED. Extrapolating these results to headache clinics, outpatient neurology clinics, and adult and pediatric primary care settings seems self-evident. As technology advances, nonmydriatic ocular Fundus imaging systems will be of higher quality and more portable and affordable, thereby circumventing the need to master the use of the ophthalmoscope. Visualizing the ocular Fundus is more important than the method used. Ocular Fundus Photography facilitates nonophthalmologists9 performance of this essential part of the physical examination, thus helping to reestablish the value of doing so.
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non mydriatic ocular Fundus Photography and telemedicine past present and future
Neuro-Ophthalmology, 2013Co-Authors: Beau B. Bruce, Nancy J. Newman, Mario A Perez, Valérie BiousseAbstract:Non-mydriatic ocular Fundus Photography is a promising alternative to direct ophthalmoscopy, particularly when combined with telemedicine. This review discusses these technologies from a longitudinal perspective: past, present, and future. The focus is directed to the role that non-mydriatic Fundus Photography and telemedicine have played in medical research and patient care, with emphasis on the major advances to date. Also discussed are the challenges to their widespread application and their substantial promise for revitalizing the importance of the ocular Fundus examination in patient care, providing improved access to ophthalmic consultative services, and facilitating clinical and epidemiologic research.
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quality of nonmydriatic digital Fundus Photography obtained by nurse practitioners in the emergency department the foto ed study
Ophthalmology, 2012Co-Authors: Cedric Lamirel, Beau B. Bruce, Nancy J. Newman, David W Wright, Kevin P Delaney, Valérie BiousseAbstract:Objective Nonmydriatic Fundus Photography by non–ophthalmic-trained personnel has recently been shown to be a potential alternative to direct ophthalmoscopy in the emergency department (ED). We evaluated the reliability of a novel quality rating scale and applied this scale to nonmydriatic Fundus photographs taken during routine ED patient encounters to determine factors associated with diminished photograph quality. Design Prospective, cross-sectional study. Participants We included 350 patients enrolled in the Fundus Photography versus Ophthalmoscopy Trials Outcomes in the Emergency Department study who were photographed by nurse practitioners after Methods Photographs of both eyes were graded for quality on 2 occasions by 2 neuro-ophthalmologists. Four regions were independently evaluated for quality: Optic disc, macula, and superior and inferior vascular arcades. Quality as a function of the number of photographs taken was evaluated by Kaplan–Meier analysis. Mixed effects ordinal logistic regression was used to evaluate for predictors of image quality while accounting for the repeated measures design. Main Outcome Measures Overall photographic quality (1–5 scale; 5 best). Results We evaluated 1734 photographs. Inter- and intraobserver agreements between neuro-ophthalmologists were very good (weighted kappa, 0.84–0.87). Quality of the optic disc area was better than those of other retinal areas ( P Conclusions Our 5-point scale is a reliable measure of nonmydriatic photograph quality. The region of interest, interphotograph interval, and patient age and race are significant predictors of image quality for nonmydriatic photographs taken by nurse practitioners in the ED. Addressing these factors may have a direct impact on the successful implementation of nonmydriatic Fundus Photography into the ED. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.
Beau B. Bruce - One of the best experts on this subject based on the ideXlab platform.
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Fundus Photography vs ophthalmoscopy outcomes in the emergency department foto ed phase iii web based in service training of emergency providers
Neuro-Ophthalmology, 2018Co-Authors: Beau B. Bruce, Nancy J. Newman, David W Wright, Samuel Bidot, Rabih Hage, Lindsay Clough, Caroline Fajolesvasseneix, Mikhail Melomed, Matthew T Keadey, Valérie BiousseAbstract:We evaluated a web-based training aimed at improving the review of Fundus Photography by emergency providers. 587 patients were included, 12.6% with relevant abnormalities. Emergency providers spen...
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ophthalmoscopy in the 21st century the 2017 h houston merritt lecture
Neurology, 2017Co-Authors: Valérie Biousse, Beau B. Bruce, Nancy J. NewmanAbstract:Although the usefulness of viewing the ocular Fundus is well-recognized, ophthalmoscopy is infrequently and poorly performed by most nonophthalmologist physicians, including neurologists. Barriers to the practice of ophthalmoscopy by nonophthalmologists include not only the technical difficulty related to direct ophthalmoscopy, but also lack of adequate training and discouragement by preceptors. Recent studies have shown that digital retinal Fundus photographs with electronic transmission and remote interpretation of images by an ophthalmologist are an efficient and reliable way to allow examination of the ocular Fundus in patients with systemic disorders such as diabetes mellitus. Ocular Fundus photographs obtained without pharmacologic dilation of the pupil using nonmydriatic Fundus cameras could be of great value in emergency departments (EDs) and neurologic settings. The Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study showed that ED providers consistently failed to correctly identify relevant ocular Funduscopic findings using the direct ophthalmoscope, and that nonmydriatic Fundus Photography was an effective alternate way of providing access to the ocular Fundus in the ED. Extrapolating these results to headache clinics, outpatient neurology clinics, and adult and pediatric primary care settings seems self-evident. As technology advances, nonmydriatic ocular Fundus imaging systems will be of higher quality and more portable and affordable, thereby circumventing the need to master the use of the ophthalmoscope. Visualizing the ocular Fundus is more important than the method used. Ocular Fundus Photography facilitates nonophthalmologists9 performance of this essential part of the physical examination, thus helping to reestablish the value of doing so.
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non mydriatic Fundus Photography a practical review for the neurologist
Practical Neurology, 2016Co-Authors: Devin D Mackay, Beau B. BruceAbstract:Declining proficiency in direct ophthalmoscopy by non-ophthalmologists has spurred a search for alternative methods of ocular Fundus examination. Recent technological advances have improved the ease of use and quality of non-mydriatic Fundus Photography, increasing its suitability for clinical care. As the availability of this technology continues to improve, neurologists will need to be familiar with its advantages, limitations and potential applications in the clinical care of patients with neurological conditions.
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non mydriatic ocular Fundus Photography and telemedicine past present and future
Neuro-Ophthalmology, 2013Co-Authors: Beau B. Bruce, Nancy J. Newman, Mario A Perez, Valérie BiousseAbstract:Non-mydriatic ocular Fundus Photography is a promising alternative to direct ophthalmoscopy, particularly when combined with telemedicine. This review discusses these technologies from a longitudinal perspective: past, present, and future. The focus is directed to the role that non-mydriatic Fundus Photography and telemedicine have played in medical research and patient care, with emphasis on the major advances to date. Also discussed are the challenges to their widespread application and their substantial promise for revitalizing the importance of the ocular Fundus examination in patient care, providing improved access to ophthalmic consultative services, and facilitating clinical and epidemiologic research.
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quality of nonmydriatic digital Fundus Photography obtained by nurse practitioners in the emergency department the foto ed study
Ophthalmology, 2012Co-Authors: Cedric Lamirel, Beau B. Bruce, Nancy J. Newman, David W Wright, Kevin P Delaney, Valérie BiousseAbstract:Objective Nonmydriatic Fundus Photography by non–ophthalmic-trained personnel has recently been shown to be a potential alternative to direct ophthalmoscopy in the emergency department (ED). We evaluated the reliability of a novel quality rating scale and applied this scale to nonmydriatic Fundus photographs taken during routine ED patient encounters to determine factors associated with diminished photograph quality. Design Prospective, cross-sectional study. Participants We included 350 patients enrolled in the Fundus Photography versus Ophthalmoscopy Trials Outcomes in the Emergency Department study who were photographed by nurse practitioners after Methods Photographs of both eyes were graded for quality on 2 occasions by 2 neuro-ophthalmologists. Four regions were independently evaluated for quality: Optic disc, macula, and superior and inferior vascular arcades. Quality as a function of the number of photographs taken was evaluated by Kaplan–Meier analysis. Mixed effects ordinal logistic regression was used to evaluate for predictors of image quality while accounting for the repeated measures design. Main Outcome Measures Overall photographic quality (1–5 scale; 5 best). Results We evaluated 1734 photographs. Inter- and intraobserver agreements between neuro-ophthalmologists were very good (weighted kappa, 0.84–0.87). Quality of the optic disc area was better than those of other retinal areas ( P Conclusions Our 5-point scale is a reliable measure of nonmydriatic photograph quality. The region of interest, interphotograph interval, and patient age and race are significant predictors of image quality for nonmydriatic photographs taken by nurse practitioners in the ED. Addressing these factors may have a direct impact on the successful implementation of nonmydriatic Fundus Photography into the ED. Financial Disclosure(s) The authors have no proprietary or commercial interest in any materials discussed in this article.
