RESUMEN
AIM: A cross-sectional descriptive study to determine the frequency of ocular manifestations associated with systemic autoimmune diseases in a third-level hospital in Mexico. METHODS: Records from 2014 to 2017 at the Inflammatory Eye Disease Clinic of the Asociación Para Evitar la Cegueraen México were examined by both an ophthalmologist and a rheumatologist on the same day. Diagnosis was achieved from initial ocular manifestations with later systemic assessment. RESULTS: Out of 311 medical records, 276 were included, 75% of the patients were female. Keratoconjunctivitis sicca was the most frequent ocular manifestation (33.3%), followed by anterior uveitis (29.5%), scleritis (23.2%), and peripheral ulcerative keratitis (7.2%). The leading autoimmune diseases were spondyloarthritis (29%), rheumatoid arthritis (28.6%), primary Sjögren's syndrome (10.5%) and granulomatosis with polyangiitis (9.1%). 41.3% of systemic disease diagnoses were made after an initial ocular manifestation. CONCLUSIONS: Inflammatory eye manifestations can imply systemic autoimmune diseases. It is crucial to suspect and confirm this association and provide timely interdisciplinary management.
Asunto(s)
Enfermedades Autoinmunes , Enfermedades de la Conjuntiva , Oftalmopatías , Oftalmología , Reumatología , Humanos , Femenino , Masculino , Estudios Transversales , México/epidemiología , Oftalmopatías/diagnóstico , Oftalmopatías/epidemiología , Oftalmopatías/etiología , Enfermedades Autoinmunes/complicaciones , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/epidemiología , Trastornos de la VisiónRESUMEN
PURPOSE: This study aimed to evaluate the classification performance of pretrained convolutional neural network models or architectures using fundus image dataset containing eight disease labels. METHODS: A publicly available ocular disease intelligent recognition database has been used for the diagnosis of eight diseases. This ocular disease intelligent recognition database has a total of 10,000 fundus images from both eyes of 5,000 patients for the following eight diseases: healthy, diabetic retinopathy, glaucoma, cataract, age-related macular degeneration, hypertension, myopia, and others. Ocular disease classification performances were investigated by constructing three pretrained convolutional neural network architectures including VGG16, Inceptionv3, and ResNet50 models with adaptive moment optimizer. These models were implemented in Google Colab, which made the task straight-forward without spending hours installing the environment and supporting libraries. To evaluate the effectiveness of the models, the dataset was divided into 70%, 10%, and 20% for training, validation, and testing, respectively. For each classification, the training images were augmented to 10,000 fundus images. RESULTS: ResNet50 achieved an accuracy of 97.1%; sensitivity, 78.5%; specificity, 98.5%; and precision, 79.7%, and had the best area under the curve and final score to classify cataract (area under the curve = 0.964, final score = 0.903). By contrast, VGG16 achieved an accuracy of 96.2%; sensitivity, 56.9%; specificity, 99.2%; precision, 84.1%; area under the curve, 0.949; and final score, 0.857. CONCLUSIONS: These results demonstrate the ability of the pretrained convolutional neural network architectures to identify ophthalmological diseases from fundus images. ResNet50 can be a good architecture to solve problems in disease detection and classification of glaucoma, cataract, hypertension, and myopia; Inceptionv3 for age-related macular degeneration, and other disease; and VGG16 for normal and diabetic retinopathy.
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Oftalmopatías , Redes Neurales de la Computación , Humanos , Oftalmopatías/clasificación , Oftalmopatías/diagnóstico , Sensibilidad y Especificidad , Reproducibilidad de los Resultados , Bases de Datos Factuales , Fondo de Ojo , Retinopatía Diabética/clasificación , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/diagnóstico por imagen , Degeneración Macular/clasificación , Degeneración Macular/diagnóstico por imagenRESUMEN
Background: Genetic eye disorders, affecting around one in 1000 people, encompass a diverse group of diseases causing severe visual deficiency. The recent adoption of next-generation sequencing techniques, including whole-exome sequencing (WES), in medicine has greatly enhanced diagnostic rates of genetically heterogeneous diseases. Objectives: The objectives of the study were to assess the diagnostic yield of WES in a cohort of Mexican individuals with suspected genetic eye disorders and to evaluate the improvement of diagnostic rates by reanalysis of WES data in patients without an initial molecular diagnosis. Methods: A total of 90 probands with ocular anomalies of suspected genetic origin were ascertained. Patients underwent WES in leukocytic DNA. Bioinformatics analysis and Sanger sequencing were used to confirm the disease-causing variants. Only variants identified as pathogenic or likely pathogenic were considered as causal. Results: Initial analysis revealed causal mutations in 46 cases (51%). Reanalysis of WES data 12 months after first analysis resulted in the identification of additional causal variants in 6 patients (7%), increasing the molecular diagnostic yield to 58%. The highest diagnostic rates by disease categories corresponded to hereditary retinal dystrophies (77%) and to anomalies of the anterior segment of the eye (47%). Conclusions: Our study demonstrates that WES is an effective approach for genetic diagnosis of genetic ocular diseases and that reanalysis of WES data can improve the diagnostic yield.
Asunto(s)
Exoma , Oftalmopatías , Oftalmopatías/diagnóstico , Oftalmopatías/genética , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Mutación , Secuenciación del Exoma/métodosRESUMEN
Introducción: La diabetes mellitus, requiere atención médica multifactorial y multisectorial. La oftalmopatía diabética demanda sistemas de salud integrados que faciliten la prevención, detección y tratamiento de las complicaciones en los niveles de atención primaria, secundaria y terciaria. Objetivo: Exponer los conceptos teóricos, prácticos y las tendencias actuales sobre diabetes mellitus y salud visual. Métodos: Se realizó una revisión bibliografía y documental sobre diabetes mellitus y salud visual, estudios y documentos publicados por instituciones nacionales e internacionales, temas vinculados a la diabetes mellitus y la salud visual, se accedió a artículos desde diferentes fuentes, revistas indexadas, metaanálisis y fuentes primarias no publicadas, tesis de maestría, y doctorados. Resultados: Para conservar la salud visual es necesario llevar a cabo medidas que conlleven a prevenir la pérdida de la visión por catarata, glaucoma, retinopatia y edema macular diabético, que incluyen no sólo un buen control de los parámetros metabólicos y las revisiones periódicas al oftalmólogo, sino también el cumplimiento de la educación diabetológica por un equipo multidisciplinario y actualización sobre este tema de los prestadores de salud. La disminución visual que provoca la catarata y otras enfermedades oculares puede conducir a padecer discapacidades como, pérdida de autonomía para administrarse los medicamentos, limitar las actividades de la vida cotidiana e incapacidad laboral y social, con la consiguiente afectación de la calidad de vida Conclusiones: Acudir al oftalmólogo con frecuencia, mantener el control glucémico, del colesterol y presión arterial representan el pilar fundamental para preservar la salud visual en el paciente diabético(AU)
Introduction: Diabetes mellitus requires multifactorial and multisectoral medical attention. Diabetic ophthalmopathy demands integrated health systems that facilitate the prevention, detection and treatment of complications at the primary, secondary and tertiary care levels. Objective: To show the theoretical and practical concepts and current trends on diabetes mellitus and visual health. Methods: A bibliographic and documentary review on diabetes mellitus and visual health was carried out. Studies and documents published by local and international institutions, articles, topics related to diabetes mellitus and visual health were retrieved from different sources, indexed journals, meta-analysis and unpublished primary sources, research degree and master's, theses. Results: To preserve visual health, it is necessary to carry out reading that lead to preventing vision loss due to cataract, glaucoma, retinopathy and diabetic macular edema, which include not only good control of metabolic parameters and regular check-ups with the ophthalmologist , but also compliance with diabetes education by a multidisciplinary team and updating the health providers on this subject. The visual decrease caused by cataract and other eye diseases can lead to disabilities such as loss of autonomy to manage medications, limit activities of daily life and work and social incapacity, with the consequent impact on quality of life. Conclusions: Frequently going to the ophthalmologist, maintaining glycemic, cholesterol and blood pressure control represent the fundamental pillar to preserve visual health in diabetic patients(AU)
Asunto(s)
Humanos , Masculino , Femenino , Catarata/diagnóstico , Salud Ocular , Diabetes Mellitus/epidemiología , Oftalmopatías/diagnósticoRESUMEN
CONTEXTO CLÍNICO: Las enfermedades vasculares del ojo son un conjunto de entidades, dentro de las que se encuentran la degeneración macular húmeda relacionada con la edad (DMRE), la retinopatía diabética (RD), entre otras. 1 La DMRE húmeda es una etapa avanzada de la DMRE seca, la cual se da por el crecimiento de vasos sanguíneos anormales debajo de la retina en un proceso llamado neovascularización coroidea (NC). Los síntomas característicos son las distorsiones visuales (por ejemplo, líneas rectas que parecen dobladas), reducción de la visión, un punto borroso o ciego en el campo visual y problemas para ver con poca luz.2,3 Suele ser la principal cause de discapacidad visual en adultos mayores. 3 La RD afecta los vasos sanguíneos de la retina (la capa de tejido sensible a la luz en la parte de atrás del ojo).4 No suele generar síntomas en sus primeras fases. Sin embargo, los primeros signos de la enfermedad pueden detectarse tomando fotografías de los ojos durante la revisión ocular de los diabéticos. Dentro de los síntomas característicos se encuentran la alteración gradual de la visión o una pérdida repentina de la visión, visión borrosa o irregular, dolor o enrojecimiento de los ojos y dificultad para ver en la oscuridad. A su vez, las alteraciones vasculares del ojo se asocian a otras alteraciones como la coriorretinopatía serosa central (CSC), un trastorno de la retina caracterizado por el desprendimiento seroso localizado de la mácula.6 La misma es secundaria a una descompensación del epitelio pigmentario de la retina y a cambios vasculares coroideos. Si bien, la mayoría de los casos se resuelven espontáneamente conservando una visión normal, algunos casos requieren tratamiento, los cuales, si no se tratan, conducen a la pérdida permanente de la visión. TECNOLOGÍA: La angiografía por tomografía de coherencia óptica es una técnica de imagen no invasiva, sin medio de contraste, que utiliza imágenes de contraste de movimiento de alta resolución usando información del flujo sanguíneo volumétrico para la generación de imágenes angiográficas en poco tiempo. 11,12 La misma adquiere imágenes para visualizar rápidamente el flujo sanguíneo, así como la presencia de crecimiento anormal de los vasos sanguíneos, que complementan el estándar actual de formación de imágenes angiográfícas. La Administración de Alimentos y Medicamentos de Estados Unidos (FDA, su sigla del inglés Food and Drug Administration) y el marcado de Conformidad Europea (CE) aprobaron este tipo de dispositivo. 13,14 La Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT) aprobó en 2020 su comercialización por un plazo de cinco años. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de el desempeño diagnóstico, eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de la angiografía por tomografía de coherencia óptica para enfermedades vasculares del ojo. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron tres RS, una ETS, seis GPC y cuatro informes de políticas de cobertura de la angiografía por tomografía de coherencia óptica para enfermedades vasculares del ojo. CONCLUSIONES: Evidencia de baja calidad sugiere que la angiografía por tomografía de coherencia óptica (OCTA) en enfermedades vasculares del ojo (degeneración macular húmeda relacionada con la edad húmeda y retinopatía diabética) puede producir un beneficio neto menor por tener una capacidad diagnóstica similar a la angiografía y evitar los efectos adversos moderados o severos relacionados a este test invasivo. Es importante destacar, que la implementación de la OCTA podría tener un impacto organizacional positivo en la institución prestadora, siempre que cuente con el dispositivo, debido la simplicidad y velocidad en la implementación de la tecnología. Las guías relevadas, que mencionan la OCTA, lo contemplan como una alternativa en pacientes con retinopatía diabética o degeneración macular húmeda relacionada con la edad, sin embargo, el método diagnóstico de referencia sigue siendo la angiografía con fluoresceína en tomografía de coherencia óptica. Las políticas de cobertura relevadas no mencionan a esta tecnología. No se encontraron estudios que evaluaran la costo-efectividad de esta tecnología para ninguna de las indicaciones evaluadas.
Asunto(s)
Humanos , Hemorragia Vítrea/diagnóstico , Vasculitis Retiniana/diagnóstico , Tomografía de Coherencia Óptica/métodos , Oftalmopatías/diagnóstico , Evaluación en Salud , Análisis Costo-BeneficioRESUMEN
The use of teleophthalmology may be a viable strategy to track and to diagnose major eye diseases primary health care patients. This study aimed to describe the performance of 30,315 telediagnoses in ophthalmology in primary care patients and the case management of this service. This is a cross-sectional study to evaluate the telediagnosis performed in patients treated at the eight remote points of the TeleOftalmo project from January 2nd, 2018, to December 31st, 2020. The patients' demographic characteristics, the reasons for referral, the diagnoses made according to age group, and the case management of the telediagnosis were evaluated. Most patients were female (66.1%), adults (70.3%), and referred to telediagnosis mainly due to reduced visual acuity (60.5%). Refractive errors were the most prevalent diagnosis in all age groups. Presbyopia was the most prevalent eye disease in adults (65.4%) and older adults (64%), followed by cataracts (41.3%) and suspected glaucoma (10.6%) in older adults. In total, 30,315 patients underwent telediagnosis, 70.5% had their ocular complaints fully resolved, without the need for referral to an in-person ophthalmologist. Telemedicine can be resolutory for the most prevalent eye diseases in the population, increasing the supply of diagnoses, qualifying and assisting in reducing waiting lines for ophthalmologic care.
O uso da teleoftalmologia pode ser uma estratégia viável para rastrear e diagnosticar as principais doenças oculares em pacientes na atenção primária à saúde. O objetivo deste estudo é descrever a realização de 30.315 telediagnósticos em oftalmologia em pacientes da atenção primária e a resolutividade desse serviço. Estudo transversal para avaliar os telediagnósticos realizados em pacientes atendidos nos oito pontos remotos do projeto TeleOftalmo entre 2 de janeiro de 2018 a 31 de dezembro de 2020. Foram avaliadas as características demográficas dos pacientes, os motivos de encaminhamento, os diagnósticos realizados conforme faixa etária e a resolutividade do telediagnóstico. Os pacientes eram, na maioria, do sexo feminino (66,1%), adultos (70,3%) e encaminhados ao telediagnóstico principalmente devido à baixa acuidade visual (60,5%). Os erros refrativos foram o diagnóstico mais prevalente em todas as faixas etárias. A presbiopia foi a doença ocular mais prevalente em adultos (65,4%) e idosos (64%), seguida da catarata (41,3%) e suspeita de glaucoma (10,6%) em idosos. Dos 30.315 pacientes que realizaram o telediagnóstico, 70,5% tiveram suas queixas oculares totalmente solucionadas, sem a necessidade de encaminhamento ao oftalmologista presencial. A telemedicina pode ser resolutiva para as doenças oculares mais prevalentes na população, aumentando a oferta de diagnósticos, qualificando e auxiliando na redução das filas de espera por atendimento oftalmológico.
La teleoftalmología puede ser una estrategia viable para el tamizaje y diagnóstico de las principales enfermedades oculares en pacientes en la atención primaria de salud. El objetivo de este estudio es describir la realización de 30.315 telediagnósticos en oftalmología en pacientes de atención primaria y la resolución de este servicio. Estudio transversal para evaluar los telediagnósticos realizados a pacientes en los ocho puntos de atención remota del proyecto TeleOftalmo entre el 2 de enero de 2018 y el 31 de diciembre de 2020. Se evaluaron las características demográficas de los pacientes, los motivos de derivación, los diagnósticos realizados según el grupo de edad y la resolución de los telediagnósticos. Los pacientes eran en su mayoría mujeres (66,1%), adultos (70,3%) y remitidos para telediagnóstico, principalmente por baja agudeza visual (60,5%). Los errores de refracción fueron el diagnóstico más prevalente en todos los grupos de edad. La presbicia fue la enfermedad ocular más frecuente en adultos (65,4%) y ancianos (64%), seguida de catarata (41,3%) y sospecha de glaucoma (10,6%) en ancianos. De los 30.315 pacientes que realizaron el telediagnóstico, el 70,5% tuvo sus quejas oculares totalmente resueltas, sin necesidad de derivación presencial al oftalmólogo. La telemedicina puede ser una herramienta útil para detectar las enfermedades oculares más prevalentes en la población debido al aumento de los diagnósticos y la ayuda que produce al reducir la lista de espera para atención oftalmológica.
Asunto(s)
Oftalmopatías , Oftalmología , Telemedicina , Anciano , Brasil , Estudios Transversales , Oftalmopatías/diagnóstico , Femenino , Humanos , Masculino , Atención Primaria de SaludRESUMEN
OBJECTIVE: To describe ophthalmic examination and diagnostic values for Schirmer tear test (STT), intraocular pressure (IOP), corneal horizontal diameter (CHD), palpebral fissure length (PFL), fundoscopy, and palpebral conjunctiva microbiota from healthy giant anteaters. ANIMALS STUDIED: Twelve giant anteaters (Myrmecophaga tridactyla), 11 adults and one juvenile, five males and seven females. PROCEDURES: The animals were submitted to general anesthesia and ophthalmic evaluation with portable slit-lamp biomicroscope, Finoff transilluminator, and fundoscopy, as well as STT, bacterial culture from palpebral conjunctiva, rebound tonometry IOP, and measurement of PFL and CHD. Data compiled were analyzed with ANOVA and Tukey tests. RESULTS: The results (mean ± standard deviation) were as follows: STT 8.04 ± 6.21 mm/min; IOP 10.92 ± 2.45 mmHg; PFL 0.75 ± 0.11 cm; CHD 0.96 ± 0.10 cm. Out of the 24 eyes swab samples for bacterial culture, 17 were positive, with three genera of Gram-positive bacteria identified Staphylococcus spp., Bacillus sp., and Corynebacterium sp. Gram-negative bacteria were not isolated from any of the samples. CONCLUSIONS: As conservation work in this vulnerable species continues, this report on basic ophthalmic examination and diagnostic parameters will be helpful improve their treatment and care. More ophthalmic studies are encouraged in animals within the Pilosa order.
Asunto(s)
Oftalmopatías , Vermilingua , Animales , Conjuntiva/microbiología , Pruebas Diagnósticas de Rutina , Oftalmopatías/diagnóstico , Oftalmopatías/veterinaria , Femenino , Presión Intraocular , Masculino , Valores de Referencia , Lágrimas , Tonometría Ocular/veterinariaRESUMEN
ABSTRACT It is part of the omic sciences to search for an understanding of how the cellular system of organisms works as well as studying their biological changes. As part of the omic sciences, we can highlight the genomics whose function is the study of genes, the transcriptomics that studies the changes in the transcripts, the proteomics responsible for understanding the changes that occur in proteins, and the metabolomics that studies all the metabolic changes that occur in a certain system when it is submitted to different types of stimuli. Metabolomics is the science that studies the endogenous and exogenous metabolites in biological systems, which aims to provide comparative quantitative or semi-quantitative information about all metabolites in the system. This review aims to describe the main applications of metabolomics science in ophthalmolog. We searched the literature on main applications of metabolomics science in ophthalmology, using the MEDLINE and LILACS databases, with the keywords "metabolomics" and "ophthalmology", from January 1, 2009, to April 5, 2021. We retrieved 216 references, of which 58 were considered eligible for intensive review and critical analysis. The study of the metabolome allows a better understanding of the metabolism of ocular tissues. The results are important to aid diagnosis and as predictors of the progression of many eye and systemic diseases.
RESUMO Faz parte das ciências ômicas buscar entender como funciona o sistema celular dos organismos e estudar suas alterações biológicas. Como parte das ciências ômicas, destacam-se a genômica, cuja função é o estudo dos genes; a transcriptômica, que estuda as mudanças nos transcritos; a proteômica, responsável por entender as mudanças que ocorrem nas proteínas, e a metabolômica, que estuda todo o metabolismo das alterações que ocorrem em um determinado sistema quando ele é submetido a diferentes tipos de estímulos. A metabolômica é a ciência que estuda os metabólitos endógenos e exógenos em sistemas biológicos, visando fornecer informações comparativas quantitativas ou semiquantitativas sobre todos os metabólitos do sistema. Esta revisão teve como objetivo descrever as principais aplicações da ciência metabolômica na oftalmologia. Trata-se de revisão narrativa desenvolvida por um grupo de pesquisa da Universidade Federal de São Paulo, em São Paulo (SP). Buscaram-se, na literatura, as principais aplicações da ciência metabolômica em oftalmologia, utilizando as bases de dados Medline® e Lilacs, com as palavras-chave "metabolomics" e "oftalmologia", de 1º de janeiro de 2009 a 5 de abril de 2021. Foram recuperadas 216 referências, das quais 58 foram consideradas elegíveis para revisão intensiva e análise crítica. O estudo do metaboloma permite um melhor entendimento do metabolismo dos tecidos oculares. Os resultados são importantes para auxiliar no diagnóstico e como preditores da progressão de muitas doenças oculares e sistêmicas.
Asunto(s)
Humanos , Oftalmopatías/metabolismo , Metaboloma/fisiología , Retina/metabolismo , Inteligencia Artificial , Biomarcadores/metabolismo , Córnea/metabolismo , Oftalmopatías/diagnóstico , Metabolómica/métodos , Aprendizaje AutomáticoRESUMEN
O uso da teleoftalmologia pode ser uma estratégia viável para rastrear e diagnosticar as principais doenças oculares em pacientes na atenção primária à saúde. O objetivo deste estudo é descrever a realização de 30.315 telediagnósticos em oftalmologia em pacientes da atenção primária e a resolutividade desse serviço. Estudo transversal para avaliar os telediagnósticos realizados em pacientes atendidos nos oito pontos remotos do projeto TeleOftalmo entre 2 de janeiro de 2018 a 31 de dezembro de 2020. Foram avaliadas as características demográficas dos pacientes, os motivos de encaminhamento, os diagnósticos realizados conforme faixa etária e a resolutividade do telediagnóstico. Os pacientes eram, na maioria, do sexo feminino (66,1%), adultos (70,3%) e encaminhados ao telediagnóstico principalmente devido à baixa acuidade visual (60,5%). Os erros refrativos foram o diagnóstico mais prevalente em todas as faixas etárias. A presbiopia foi a doença ocular mais prevalente em adultos (65,4%) e idosos (64%), seguida da catarata (41,3%) e suspeita de glaucoma (10,6%) em idosos. Dos 30.315 pacientes que realizaram o telediagnóstico, 70,5% tiveram suas queixas oculares totalmente solucionadas, sem a necessidade de encaminhamento ao oftalmologista presencial. A telemedicina pode ser resolutiva para as doenças oculares mais prevalentes na população, aumentando a oferta de diagnósticos, qualificando e auxiliando na redução das filas de espera por atendimento oftalmológico.
The use of teleophthalmology may be a viable strategy to track and to diagnose major eye diseases primary health care patients. This study aimed to describe the performance of 30,315 telediagnoses in ophthalmology in primary care patients and the case management of this service. This is a cross-sectional study to evaluate the telediagnosis performed in patients treated at the eight remote points of the TeleOftalmo project from January 2nd, 2018, to December 31st, 2020. The patients' demographic characteristics, the reasons for referral, the diagnoses made according to age group, and the case management of the telediagnosis were evaluated. Most patients were female (66.1%), adults (70.3%), and referred to telediagnosis mainly due to reduced visual acuity (60.5%). Refractive errors were the most prevalent diagnosis in all age groups. Presbyopia was the most prevalent eye disease in adults (65.4%) and older adults (64%), followed by cataracts (41.3%) and suspected glaucoma (10.6%) in older adults. In total, 30,315 patients underwent telediagnosis, 70.5% had their ocular complaints fully resolved, without the need for referral to an in-person ophthalmologist. Telemedicine can be resolutory for the most prevalent eye diseases in the population, increasing the supply of diagnoses, qualifying and assisting in reducing waiting lines for ophthalmologic care.
La teleoftalmología puede ser una estrategia viable para el tamizaje y diagnóstico de las principales enfermedades oculares en pacientes en la atención primaria de salud. El objetivo de este estudio es describir la realización de 30.315 telediagnósticos en oftalmología en pacientes de atención primaria y la resolución de este servicio. Estudio transversal para evaluar los telediagnósticos realizados a pacientes en los ocho puntos de atención remota del proyecto TeleOftalmo entre el 2 de enero de 2018 y el 31 de diciembre de 2020. Se evaluaron las características demográficas de los pacientes, los motivos de derivación, los diagnósticos realizados según el grupo de edad y la resolución de los telediagnósticos. Los pacientes eran en su mayoría mujeres (66,1%), adultos (70,3%) y remitidos para telediagnóstico, principalmente por baja agudeza visual (60,5%). Los errores de refracción fueron el diagnóstico más prevalente en todos los grupos de edad. La presbicia fue la enfermedad ocular más frecuente en adultos (65,4%) y ancianos (64%), seguida de catarata (41,3%) y sospecha de glaucoma (10,6%) en ancianos. De los 30.315 pacientes que realizaron el telediagnóstico, el 70,5% tuvo sus quejas oculares totalmente resueltas, sin necesidad de derivación presencial al oftalmólogo. La telemedicina puede ser una herramienta útil para detectar las enfermedades oculares más prevalentes en la población debido al aumento de los diagnósticos y la ayuda que produce al reducir la lista de espera para atención oftalmológica.
Asunto(s)
Humanos , Masculino , Femenino , Anciano , Oftalmología , Telemedicina , Oftalmopatías/diagnóstico , Atención Primaria de Salud , Brasil , Estudios TransversalesRESUMEN
Recently, it has been recommended that population-based studies report not only frequencies of vision impairment and blindness but also any ocular abnormalities that might lead an individual to seek for eyecare services. The current study aimed to determine prevalence of ocular findings regardless of visual acuity (VA) status in older adults from the Brazilian Amazon Region. Disturbances were grouped into: Eyelids; Anterior Segment; Posterior Segment; Increased intraocular pressure; and Overall Globe. The presence of an ocular finding was considered positive when any abnormality was noted, regardless of VA. Refractive errors were not considered. A total 2384 eligible persons were enumerated and 2041 (85.6%) examined. The prevalence of ocular disturbances in either eye was 87.0% and was associated with male gender, older age, lower education, and rural residence. Overall, main findings were pterygium, cataract, and pinguecula, occurring in 58.8%, 45.4% and 17.4%, respectively. Among individuals with 20/20 VA in both eyes, the most frequent findings were pterygium, pinguecula, and glaucoma cupping, occurring in 47.4%, 31.2% and 6.5%, respectively. The high prevalence of ocular findings observed in this population reinforces that different conditions might not immediately decrease VA but can indicate risk and/or discomfort symptoms and should be considered when planning public health ophthalmic services.
Asunto(s)
Oftalmopatías/epidemiología , Evaluación Geriátrica/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Oftalmopatías/diagnóstico , Oftalmopatías/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Prevalencia , Factores de Riesgo , Agudeza VisualRESUMEN
Telemedicine can be used to conduct ophthalmological assessment of patients, facilitating patient access to specialist care. Since the teleophthalmology models require data collection support from other health professionals, the purpose of our study was to assess agreement between the nursing technician and the ophthalmologist in acquisition of health parameters that can be used for remote analysis as part of a telemedicine strategy. A cross-sectional study was conducted with 140 patients referred to an ophthalmological telediagnosis center by primary healthcare doctors. The health parameters evaluated were visual acuity (VA), objective ophthalmic measures acquired by autorefraction, keratometry, and intraocular pressure (IOP). Bland-Altman plots were used to analyze agreement between the nursing technician and the ophthalmologist. The Bland-Altman analysis showed a mean bias equal to zero for the VA measurements [95%-LoA: -0.25-0.25], 0.01 [95%-LoA: -0.86-0.88] for spherical equivalent (M), -0.08 [95%-LoA: -1.1-0.95] for keratometry (K) and -0.23 [95%-LoA: -4.4-4.00] for IOP. The measures had a high linear correlation (R [95%CI]: 0.87 [0.82-0.91]; 0.97 [0.96-0.98]; 0.96 [0.95-0.97] and 0.88 [0.84-0.91] respectively). The results observed demonstrate that remote ophthalmological data collection by adequately trained health professionals is viable. This confirms the utility and safety of these solutions for scenarios in which access to ophthalmologists is limited.
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Oftalmopatías/diagnóstico , Presión Intraocular , Personal de Enfermería , Oftalmólogos , Telemedicina , Tonometría Ocular , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oftalmología , Atención Primaria de SaludRESUMEN
PURPOSE: This study aimed to identify patient's reason for no-show at a university eye clinic after ophthalmic examination via a mobile ophthalmic unit, which provides comprehensive ophthalmic care to underserved communities in a region of Brazil. METHODS: In 2017/2018, this prospective observational study searched for no-shows at referrals to a university eye clinic after an outreach program screening via a mobile ophthalmic unit in 10 municipalities in the central-western region of São Paulo, Brazil. A total of 1,928 patients underwent a comprehensive eye examination at no cost, and 37.1% of them needed referral to a university eye clinic for specialized examinations or surgeries. We used the following two main tools: (1) comparative analysis between patients who attended the referral and those who did not; (2) active search using a questionnaire to assess reasons for no-show. RESULTS: Attendance to referrals was not influenced by age, gender, distance from the university hospital, number of ophthalmologists in the municipality, average family income, and visual acuity. The main cause for referrals was cataract (350 cases). No-show was most common among glaucoma/suspected glaucoma (54.1%) cases, followed by strabismus (45%) and anterior segment disease (33.6%) cases. Many patients who did not attend the referral sought another service. CONCLUSION: Patient's issues and lack of knowledge regarding their ophthalmic condition are the main reasons for no-show at referrals for free ophthalmic care. Thus, educational campaigns are needed to achieve consistently high attendance to prevent avoidable blindness.
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Oftalmopatías , Pacientes no Presentados , Derivación y Consulta , Brasil , Oftalmopatías/diagnóstico , HumanosRESUMEN
PURPOSE: To provide a descriptive investigation about relevant features of the crested caracara's eye (Caracara plancus) and bony orbit, as well as provide data for ophthalmic tests. METHODS: Morphological observations and the following diagnostic tests were performed: Schirmer tear test (STT), conjunctival flora evaluation, corneal touch threshold (CTT), intraocular pressure (IOP), central corneal thickness (CCT), B-mode ocular biometry, palpebral fissure length (PFL), and corneal diameter (CD) in 19 healthy birds, plus two macerated skulls. Not all birds were used for each test. RESULTS: STT: 7.84 ± 3.05 mm/min; CTT: 2.46 ± 1.10 cm; IOP: 19.18 ± 3.07 mmHg; CCT: 0.31 ± 0.02 mm; PFL: 13.32 ± 1.06 mm; CD: 10.26 ± 2.43 mm; Axial globe length: 1.89 ± 0.06 cm; Anterior chamber depth: 0.27 ± 0.06 cm; Lens axial length: 4.55 ± 0.06 cm; Vitreous chamber depth: 1.2 ± 0.07 cm. The most frequent conjunctival bacterial isolates were Corynebacterium sp. (10/23.8%), Staphylococcus sp. (9/21.42%), Streptococcus sp. (7/16.6%), and E. coli (7/16.66%). The large lateral part of the palatine bone likely plays a role in the ventral protection of the globe against the impact of prey. Observed results are generally reflective of increased body mass compared to other Falconiformes, with values approaching those of similar sized Accipitriformes. CONCLUSIONS: These data may help veterinarians recognize peculiar morphologic features and perform a more accurate diagnosis of eye diseases of this avian species.
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Oftalmopatías/veterinaria , Ojo/anatomía & histología , Falconiformes/anatomía & histología , Animales , Córnea/fisiología , Técnicas de Diagnóstico Oftalmológico/veterinaria , Ojo/microbiología , Oftalmopatías/diagnóstico , Oftalmopatías/microbiología , Femenino , Masculino , Fenómenos Fisiológicos Oculares , Órbita/anatomía & histología , LágrimasAsunto(s)
Oftalmopatías/diagnóstico , Enfermedades Genéticas Congénitas/diagnóstico , Proteínas de Microfilamentos/genética , Adulto , Argentina , Niño , Oftalmopatías/genética , Oftalmopatías/inmunología , Enfermedades Genéticas Congénitas/genética , Enfermedades Genéticas Congénitas/inmunología , Humanos , Leucopenia/diagnóstico , Leucopenia/genética , Leucopenia/inmunología , Masculino , Hermanos , Adulto JovenRESUMEN
Visual development begins at birth and continues throughout childhood. Ocular pathology can lead to permanent visual impairment and subsequent problems in overall development and school performance as well as signify serious systemic disease or even life-threatening malignancies. Prompt identification of congenital or early acquired ocular pathology via regular bedside ocular examinations and assessments of visual behaviors by neonatal clinicians is a critical component of newborn care. The goal of this article is to review the components of the newborn eye examination, describe key ocular findings and diagnoses that are common or critical to identify in the newborn period, and offer guidance on necessity and timing of ophthalmology referral.
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Oftalmopatías , Oftalmopatías/diagnóstico , Humanos , Recién Nacido , Examen FísicoRESUMEN
Se describen como desafíos actuales en mucopolisacaridosis I la necesidad de una clasificación adecuada, vinculándola a las indicaciones terapéuticas; el diagnóstico temprano desde la pesquisa neonatal, sus ventajas y dificultades hasta la sospecha clínica de las formas grave y atenuada; el cuidado de la patología espinal y oftalmológica, desde el diagnóstico, el seguimiento y el tratamiento; las reacciones alérgicas por terapia de reemplazo enzimático, su diagnóstico y tratamiento. Por último, la transición hacia el cuidado adulto
Here we describe the current challenges of mucopolysaccharidosis type I: the need for an adequate classification, establishing its relationship to therapeutic indications; an early diagnosis, from neonatal screening, its advantages and barriers, to clinical suspicion of severe and attenuated forms; spinal and eye disease care, from diagnosis to follow-up and treatment; allergic reactions caused by enzyme replacement therapy, their diagnosis and treatment. And lastly, transition to adult care
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Mucopolisacaridosis I/diagnóstico , Mucopolisacaridosis I/terapia , Tamizaje Neonatal , Mucopolisacaridosis I/clasificación , Oftalmopatías/diagnóstico , Oftalmopatías/terapia , Transición a la Atención de Adultos , Hipersensibilidad/diagnóstico , Hipersensibilidad/terapiaRESUMEN
Objective: Diabetes can affect the eye in many ways beyond retinopathy. This study sought to evaluate ocular disease and determine any associations with peripheral neuropathy (PN) or cardiac autonomic neuropathy (CAN) in type 2 diabetes (T2D) and Charcot arthropathy (CA) patients. Design: A total of 60 participants were included, 16 of whom were individuals with T2D/CA, 21 of whom were individuals with T2D who did not have CA, and 23 of whom were healthy controls. Ocular surface evaluations were performed, and cases of dry eye disease (DED) were determined using the Ocular Surface Disease Index (OSDI) questionnaire, ocular surface staining, Schirmer test, and Oculus Keratograph 5M exams. All variables were used to classify DED and ocular surface disorders such as aqueous deficiency, lipid deficiency, inflammation, and ocular surface damage. Pupillary and retinal nerve fiber measurements were added to the protocol in order to broaden the scope of the neurosensory ocular evaluation. PN and CAN were ascertained by clinical examinations involving the Neuropathy Disability Score (for PN) and Ewing's battery (for CAN). Results: Most ocular variables evaluated herein differed significantly between T2D patients and controls. When the controls were respectively compared to patients with T2D and to patients with both T2D and CA, they differed substantially in terms of visual acuity (0.92 ± 0.11, 0.73 ± 0.27, and 0.47 ± 0.26, p=0.001), retinal nerve fiber layer thickness (96.83 ± 6.91, 89.25 ± 10.44, and 80.37 ± 11.67 µm, p=0.03), pupillometry results (4.10 ± 0.61, 3.48 ± 0.88, and 2.75 ± 0.81 mm, p=0.0001), and dry eye symptoms (9.19 ± 11.71, 19.83 ± 19.08, and 24.82 ± 24.40, p=0.03). DED and ocular surface damage also differed between individuals with and without CA, and were associated with PN and CAN. Conclusion: CA was found to be significantly associated with the severity of ocular findings. DED in cases of CA was also associated with PN and CAN. These findings suggest that intrinsic and complex neurosensory impairment in the eyes, peripheral sensory nerves, and the autonomic nervous system are somehow connected. Thus, a thorough ocular evaluation may be useful to highlight neurological complications and the impact of diabetes on ocular and systemic functions and structures.
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Artropatía Neurógena/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Neuropatías Diabéticas/epidemiología , Oftalmopatías/epidemiología , Anciano , Artropatía Neurógena/complicaciones , Brasil/epidemiología , Estudios de Casos y Controles , Estudios Transversales , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Neuropatías Diabéticas/etiología , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/epidemiología , Retinopatía Diabética/etiología , Síndromes de Ojo Seco/epidemiología , Síndromes de Ojo Seco/etiología , Oftalmopatías/diagnóstico , Oftalmopatías/etiología , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To compare neonatal eye screening using the red reflex test (RRT) versus the wide-field digital imaging (WFDI) system. METHODS: Prospective cohort study. Newborns (n = 380, 760 eyes) in the Maternity Ward of Irmandade Santa Casa de Misericórdia de São Paulo hospital from May to July 2014 underwent RRT by a paediatrician and WFDI performed by the authors. Wide-field digital imaging (WFDI) images were analysed by the authors. Validity of the paediatrician's RRT was assessed by unweighted kappa [κ] statistic, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). RESULTS: While WFDI showed abnormalities in 130 eyes (17.1%), RRT was only abnormal in 13 eyes (1.7%). Wide-field digital imaging (WFDI) detected treatable retina pathology that RRT missed including hyphema, CMV retinitis, FEVR and a vitreous haemorrhage. The sensitivity of the paediatrician's RRT to detect abnormalities was poor at 0.77% (95% confidence interval, CI, 0.02%-4.21%) with a PPV of only 7.69% (95% CI, 1.08%-38.85%). Overall, there was no agreement between screening modalities (κ = -0.02, 95% CI, -0.05 to 0.01). The number needed to screen to detect ocular abnormalities using WFDI was 5.9 newborns and to detect treatable abnormalities was 76 newborns. CONCLUSION: While RRT detects gross abnormalities that preclude visualization of the retina (i.e. media opacities and very large tumours), only WFDI consistently detects subtle treatable retina and optic nerve pathology. With a higher sensitivity than the current gold standard, universal WFDI allows for early detection and management of potentially blinding ophthalmic disease missed by RRT.
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Oftalmopatías/diagnóstico , Tamizaje Neonatal/métodos , Nervio Óptico/diagnóstico por imagen , Reflejo/fisiología , Retina/diagnóstico por imagen , Brasil/epidemiología , Oftalmopatías/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Recién Nacido , Masculino , Oftalmoscopía/métodos , Nervio Óptico/fisiopatología , Valor Predictivo de las Pruebas , Estudios Prospectivos , Retina/fisiopatologíaRESUMEN
The safety assessment of cosmetic products is based on the safety of the ingredients, which requires information on chemical structures, toxicological profiles, and exposure data. Approximately 6% of the population is sensitized to cosmetic ingredients, especially preservatives and fragrances. In this context, the aim of this study was to perform a hazard assessment and risk characterization of benzalkonium chloride (BAC), benzyl alcohol (BA), caprylyl glycol (CG), ethylhexylglycerin (EG), chlorphenesin (CP), dehydroacetic acid (DHA), sodium dehydroacetate (SDH), iodopropynyl butylcarbamate (IPBC), methylchloroisothiazolinone and methylisothiazolinone (MCI/MIT), methylisothiazolinone (MIT), phenoxyethanol (PE), potassium sorbate (PS), and sodium benzoate (SB). Considering the integrated approaches to testing and assessment (IATA) and weight of evidence (WoE) as a decision tree, based on published safety reports. The hazard assessment was composed of a toxicological matrix correlating the toxicity level, defined as low (L), moderate (M), or high (H) and local or systemic exposure, considering the endpoints of skin sensitization, skin irritation, eye irritation, phototoxicity, acute oral toxicity, carcinogenicity, mutagenicity/genotoxicity, and endocrine activity. In a risk assessment approach, most preservatives had a margin of safety (MoS) above 100, except for DHA, SDH, and EG, considering the worst-case scenario (100% dermal absorption). However, isolated data do not set up a safety assessment. It is necessary to carry out a rational risk characterization considering hazard and exposure assessment to estimate the level of risk of an adverse health outcome, based on the concentration in a product, frequency of use, type of product, route of exposure, body surface location, and target population.