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Audit of Web-based telemedicine in ophthalmology

Kennedy C, Bowman R, Fariza N, Ackuaku E, Ntim-Amponsah C, Murdoch I

J Telemed Telecare, 2006;12(2):88-91.
PMID: 16539756

A Web-based service was set up to link subspecialist ophthalmologists with those seeking advice on particular clinical problems in ophthalmology. The service operated between countries, with centres in Malaysia, Ghana, Tanzania, South Africa and Gambia seeking advice from Moorfields Eye Hospital in the UK. It also operated within country, where a rural clinic in The Gambia sought advice from the central hospital on difficult cases or cases for possible referral. Provision of Web access and training in image capture and manipulation were undertaken in each participating centre. During the first 12 months, 132 cases were posted to the Website from five of the six centres participating. The rate of case referral rose to about 12-14 cases per month by the end of the study. Overall, 24% of referrals did not use images. In the first four months the response time was 13 days, and in the last four months it was three days. Most cases were answered with a single response from the specialist. The main problem was the amount of Internet down-time in each of the locations. The main benefit was safe and reliable access to specialist advice for practitioners.

Matched MeSH terms: Eye Diseases/diagnosis*
Fulltext Giant cell arteritis with panocular involvement in an Indian male

Fathilah J, Jamaliah R

Med J Malaysia, 2003 Mar;58(1):111-4.
PMID: 14556335

A case of giant cell arteritis with systemic and panocular involvement is reported here. This elderly Indian male presented with symptoms of unilateral temporal headache and intermittent jaw claudication for a month followed by diplopia and blurring of vision and later loss of vision in the right eye. The right eye showed some limitation of ocular movements, presence of relative afferent pupil defect, anterior segment ischaemic changes and anterior ischaemic optic neuropathy. Visual evoked potential showed an absent P1 wave while the left eye with normal 6/6 vision sowed a prolonged P1 wave. Fundus fluoresceine angiography showed delay in choroidal perfusion. His erythrocyte sedimentation rate (ESR) was 120 mm/hr and he was started on oral prednisolone. Superficial temporal artery biopsy obtained one week after starting steroids was positive for giant cell arteritis. Steroids led to the resolution of optic disc swelling, disappearance of anterior segment signs, full recovery of right ocular movements and no further deterioration of the fellow eye. On steroids, he developed insomnia and progressive myopathy which resolved and is now symptom free at lower doses of steroids.

Matched MeSH terms: Eye Diseases/diagnosis*
Fulltext Comparison of open-ended and close-ended questions to determine signs and symptoms of eye problems among children

Chen AH, Bakar NA, Lam CS

J Optom, 2019 10 16;13(2):81-87.
PMID: 31629682 DOI: 10.1016/j.optom.2019.07.002

BACKGROUND: Parents play important role in providing information regarding their children's health status to healthcare providers. However, parents' ability in reporting signs and symptoms of eye problems among their children required more in-depth investigation. Our study aimed to compare the differences of parental report regarding eye problems among their children using two different question approaches.
METHODS: A total of 416 parents with children aged between two months old and 17 years old were participated in this cross-sectional survey. The responses of parents' observation on signs and symptoms of eye problems were compared between one open-ended question and ten close-ended questions. We also examined the demographic contributing factors that could influence parental responses.
RESULTS: The total count of reported signs and symptoms through open-ended and close-ended question was 164 and 529 reports, respectively. Parents reported more diverse (70% higher) categories of signs and symptoms in open-ended compared to close-ended questions. Parent's ability to report eye problems using open-ended question was associated with their gender (p<0.05), but no similar significant association was found in close-ended questions.
CONCLUSION: Parents reported more signs and symptoms of eye problems among their children through close-ended questions (regardless of gender) and more diversified categories through open-ended question in this study suggested that different communication approaches might be needed in clinical practice between those who requested specific appointment and those attending screening or routine assessment. The discrepancy might imply the importance to enhance the parent's role in preventive eye care. Effective communication between eyecare providers and parents has the potential to improve paediatric eyecare delivery.

Matched MeSH terms: Eye Diseases/diagnosis*
Fulltext Ophthalmology inpatient consultation: does it make a difference to inpatient management?

Tajunisah I, Azida J, Zurina ZA, Reddy SC

Med J Malaysia, 2009 Jun;64(2):130-3.
PMID: 20058572 MyJurnal

Ophthalmology consultation is one of the commonest requested services for inpatients in a tertiary hospital. A total of 290 ophthalmology consultation requests were received over a period of six months (average 12 consultation requests per week) and from these, 222 patients were examined. The patient demographics, the hospitalization data, type of consultations (screening, new problem, preexisting problem), reasons for consultations and the ophthalmology diagnosis were determined. Out of 290 consultation requests, internal medicine services requested the highest number (95, 32.8%); the commonest type of consultation was screening for eye diseases (161, 55.5%) and the most common reason for consultation was to rule out diabetic retinopathy (125, 43.1%). The top five ophthalmology diagnoses after examination were diabetic retinopathy (45, 20.3%), diabetic retinopathy ruled out (37, 16.6%), conjunctivitis (12, 5.4%), refractive error (11, 4.8%) and normal ocular examination (11, 4.9%). Inpatient ophthalmologic procedures were performed in 146 patients, the commonest of which was retinal laser photocoagulation. A total of 133 (59.9%) inpatients had a change in their management as a result of the ophthalmology consultation.

Matched MeSH terms: Eye Diseases/diagnosis
Automatic tracing of optic disc and exudates from color fundus images using fixed and variable thresholds

Reza AW, Eswaran C, Hati S

J Med Syst, 2009 Feb;33(1):73-80.
PMID: 19238899

The detection of bright objects such as optic disc (OD) and exudates in color fundus images is an important step in the diagnosis of eye diseases such as diabetic retinopathy and glaucoma. In this paper, a novel approach to automatically segment the OD and exudates is proposed. The proposed algorithm makes use of the green component of the image and preprocessing steps such as average filtering, contrast adjustment, and thresholding. The other processing techniques used are morphological opening, extended maxima operator, minima imposition, and watershed transformation. The proposed algorithm is evaluated using the test images of STARE and DRIVE databases with fixed and variable thresholds. The images drawn by human expert are taken as the reference images. The proposed method yields sensitivity values as high as 96.7%, which are better than the results reported in the literature.

Matched MeSH terms: Eye Diseases/diagnosis*
Fulltext Awareness and knowledge of common eye diseases among the academic staff (non-medical faculties) of University of Malaya

Chew YK, Reddy SC, Karina R

Med J Malaysia, 2004 Aug;59(3):305-11.
PMID: 15727374 MyJurnal

A cross sectional study was conducted to assess the level of awareness and knowledge of common eye diseases (cataract, glaucoma, diabetic retinopathy and refractive errors) among 473 academic staff (non-medical faculties) of University Malaya. The awareness of cataract was in 88.2%, diabetic retinopathy in 83.5%, refractive errors in 75.3% and glaucoma in 71.5% of the study population. The knowledge about all the above common eye diseases was moderate, except presbyopia which was poor. Multivariate analysis revealed that females, older people, and those having family history of eye diseases were significantly more aware and more knowledgeable about the eye diseases. Health education about eye diseases would be beneficial to seek early treatment and prevent visual impairment in the society.

Matched MeSH terms: Eye Diseases/diagnosis*
Ocular symptoms and tear film break up time (BUT) among junior high school students in Penang, Malaysia - Associations with fungal DNA in school dust

Norbäck D, Hashim JH, Hashim Z, Sooria V, Ismail SA, Wieslander G

Int J Hyg Environ Health, 2017 06;220(4):697-703.
PMID: 28254266 DOI: 10.1016/j.ijheh.2017.01.016

BACKGROUND: There are few studies on ocular effects of indoor mould exposure in schools, especially in the tropics OBJECTIVE: To study associations between eye symptoms and tear film break up time (BUT) in students and demographic data and fungal DNA in schools.
METHODS: A school environment study was performed among randomly selected students in eight randomly selected secondary schools in Penang, Malaysia. Information on eye symptoms and demographic data was collected by a standardised questionnaire. BUT was measured by two methods, self-reported BUT (SBUT) and by the non-invasive Tearscope (NIBUT). Dust was collected by vacuuming in 32 classrooms and analysed for five fungal DNA sequences. Geometric mean (GM) for total fungal DNA was 7.31*104 target copies per gram dust and for Aspergillus/Penicillium DNA 3.34*104 target copies per gram dust. Linear mixed models and 3-level multiple logistic regression were applied adjusting for demographic factors.
RESULTS: A total of 368 students (58%) participated and 17.4% reported weekly eye symptoms the last 3 months. The median SBUT and TBUT were 15 and 12s, respectively. Students wearing glasses (OR 2.41, p=0.01) and with a history of atopy (OR=2.67; p=0.008) had more eye symptoms. Girls had less eye symptoms than boys (OR=0.34; p=0.006) Indoor carbon dioxide in the classrooms was low (range 380-720ppm), temperature was 25-30°C and relative air humidity 70-88%. Total fungal DNA in vacuumed dust was associated with shorter SBUT (4s shorter per 105 target copies per gram dust; p=0.04) and NIBUT (4s shorter per 105 target copies per gram dust; p<0.001). Aspergillus/Penicillium DNA was associated with shorter NIBUT (5s shorter per 105 target copies per gram dust; p=0.01).
CONCLUSION: Fungal contamination in schools in a tropical country can be a risk factor for impaired tear film stability among students.

Matched MeSH terms: Eye Diseases/diagnosis
Fulltext Leucocoria in a boy with Kawasaki disease: a diagnostic challenge

Che Mahiran CD, Alagaratnam J, Liza-Sharmini AT

Singapore Med J, 2009 Jul;50(7):e232-4.
PMID: 19644606

Retinoblastoma, the most common primary intraocular malignancy of childhood, usually presents in the first three years of life. Atypical presentation of retinoblastoma can masquerade as virtually any ocular or orbital pathology, which may lead to diagnostic dilemmas especially in the presence of other systemic diseases. We report a 20-month-old boy who was diagnosed with coronary aneurysm as a complication of Kawasaki disease, and presented with sudden left eye redness. His mother noticed the presence of white pupillary reflex three months earlier. Atypical acute ocular presentation secondary to Kawasaki disease was initially suspected, but the presence of multiple calcification and mild proptosis on imaging suggested characteristics of advanced retinoblastoma. Histopathological examination of the enucleated eye, which revealed a classical rosette pattern appearance, confirmed the diagnosis. Atypical presentations of retinoblastoma are usually associated with advanced disease. The presence of other systemic conditions further complicates the diagnosis. Early diagnosis is important to reduce the mortality and morbidity.

Matched MeSH terms: Eye Diseases/diagnosis