Objective The main objective of this study is to determine the agreement between the clinical staging of diabetic retinopathy (DR) with fluorescein angiography (FA) staging in an actual clinic.
Diabetic Retinopathy ; Fluorescein Angiography ; Ophthalmoscopy ; Diabetes Mellitus

PURPOSE: To compare parameters of confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] II) in high myopia with age- and sex-matched emmetropes. METHODS: A hospital-based cross-sectional study was conducted among Nepalese subjects aged 18 to 35 years at BP Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Maharajgunj, Kathmandu from November 2015 to October 2016. Fifty consecutive subjects with high myopia (spherical equivalent ranging from −6.00 to −12.00 diopters) and age- and sex-matched emmetropic subjects were enrolled for comparison. Correlations between disc area and other HRT parameters, asymmetry between the right and left eyes, and comparisons between male and female subjects in both high myopic and emmetropic groups were evaluated. RESULTS: Disc area was not significantly (p = 0.11) larger in high myopic eyes than in emmetropic eyes. HRT parameters in highly myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes. Disc area was found to be significantly positively correlated with inter disc parameters and significantly negatively correlated with rim to disc area ratio in the high myopia group. Disc area and other intra-disc parameters showed significant correlations between right and left eyes in both high myopia and emmetropia, and no significant differences between males and females from a Nepalese population. CONCLUSIONS: Characteristics of HRT parameters in high myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes in a Nepalese population. The effect of disc area on HRT parameters differed significantly only in height variation contour by emmetropic eyes.
Cross-Sectional Studies ; Emmetropia ; Female ; Humans ; Institute of Medicine (U.S.) ; Lions ; Male ; Myopia ; Ophthalmoscopy ; Optic Disk ; Optic Nerve ; Retinaldehyde

PURPOSE: We detected retinal nerve fiber layer (RNFL) defects using a confocal scanning laser ophthalmoscopy (CSLO) with both blue and green laser sources and evaluated image quality based on laser wavelength. METHODS: This was a retrospective observational case study. Blue and green CSLO images of 181 eyes with suspected glaucoma were evaluated and compared. Three independent observers identified the presence of RNFL defects and determined which CSLO imaging source provided superior visibility of the defect. After assessing the defect imaging by laser source, demographics and image quality indices of optical coherence tomography between blue better and green better groups were analyzed. RESULTS: Both blue and green CSLO showed high discriminating ability for RNFL defects. The discriminating ability of blue CSLO was significantly greater than that of green CSLO (p = 0.004). Among eyes with a detectable RNFL defect, 61.8% were better visualized with the blue laser compared to the green laser. Compared with the blue better group, the green better group was significantly older (p = 0.009), had a greater proportion of females (p = 0.005), had poorer best-corrected visual acuity (p = 0.001), more severe cataracts (p = 0.001), lower signal strength (p = 0.003), and poor image quality indices (p = 0.001). CONCLUSIONS: Both blue and green CSLO imaging was useful for detecting RNFL defects, but blue CSLO was superior to green CSLO in quality of RNFL defect imaging in most patients with clear media.
Cataract ; Demography ; Female ; Glaucoma ; Humans ; Nerve Fibers ; Ophthalmoscopes ; Ophthalmoscopy ; Retinaldehyde ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: We report a case of utilizing a previous silicone band track in the reoperation of scleral encircling. CASE SUMMARY: An 8-year-old male presented with rhegmatogenous retinal detachment in the right eye. Five days after this diagnosis, he received scleral buckling surgery and cryopexy to seal the retinal tear. One month after surgery, a fundus examination showed subretinal fluid at the inferior site of the scleral buckle. He underwent scleral encircling surgery and a cryopexy procedure. The patient has had an uneventful postoperative course, and the retina has remained attached over a follow-up period of 9 months. However, exotropia and hypotropia developed in the right eye. Diagnosis of restrictive strabismus due to tissue adhesion around the silicone band was made. The encircling band was therefore removed and laser photocoagulation was performed 360° around the retina. Twenty-four hours after surgery, a fundus examination showed subretinal fluid. He received 360° scleral encircling surgery not using the 360° conjunctival peritomy. After confirming a previous encircling tract using #0-0 polydioxanone as a guide, #5-0 Nylon was tied to the end of the guide and inserted through the encircling tract with the end sutured with the silicone band. The silicone band was inserted into the encircling tract by pulling the #5-0 Nylon as a guide. Ophthalmoscopy revealed an attached retina with indentation of the scleral buckle at 360°. CONCLUSIONS: For reoperation in patients who previously underwent scleral encircling surgery, using the previous scleral encircling tract may be effective in cases with conjunctival and tissue adhesion.
Child ; Diagnosis ; Exotropia ; Follow-Up Studies ; Humans ; Light Coagulation ; Male ; Nylons ; Ophthalmoscopy ; Polydioxanone ; Reoperation ; Retina ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Scleral Buckling ; Silicon ; Silicones ; Strabismus ; Subretinal Fluid ; Tissue Adhesions

Computerized adaptive testing (CAT) greatly improves measurement efficiency in high-stakes testing operations through the selection and administration of test items with the difficulty level that is most relevant to each individual test taker. This paper explains the 3 components of a conventional CAT item selection algorithm: test content balancing, the item selection criterion, and item exposure control. Several noteworthy methodologies underlie each component. The test script method and constrained CAT method are used for test content balancing. Item selection criteria include the maximized Fisher information criterion, the b-matching method, the a-stratification method, the weighted likelihood information criterion, the efficiency balanced information criterion, and the Kullback-Leibler information criterion. The randomesque method, the Sympson-Hetter method, the unconditional and conditional multinomial methods, and the fade-away method are used for item exposure control. Several holistic approaches to CAT use automated test assembly methods, such as the shadow test approach and the weighted deviation model. Item usage and exposure count vary depending on the item selection criterion and exposure control method. Finally, other important factors to consider when determining an appropriate CAT design are the computer resources requirement, the size of item pools, and the test length. The logic of CAT is now being adopted in the field of adaptive learning, which integrates the learning aspect and the (formative) assessment aspect of education into a continuous, individualized learning experience. Therefore, the algorithms and technologies described in this review may be able to help medical health educators and high-stakes test developers to adopt CAT more actively and efficiently.
Animals ; Cats ; Education ; Health Educators ; Humans ; Learning ; Logic ; Methods ; Patient Selection ; Retinoscopy ; Test Taking Skills

PURPOSE: To evaluate the effectiveness of a cycloplegic regimen using 0.5% tropicamide and 0.5% phenylephrine (Tropherine, Hanmi Pharm), in addition to 1% cyclopentolate, in hyperopic children. METHODS: The medical records of hyperopic patients below the age of 14 years who had undergone cycloplegic retinoscopy were retrospectively reviewed. Cycloplegic refractions were performed using one of two cycloplegic regimens. Regimen 1 was a Tropherine-added regimen comprising the administration of one drop of 1% cyclopentolate followed by two to three drops of Tropherine added at 15-minute intervals. Regimen 2 was a cyclopentolate-only regimen comprising the administration of three to four drops of 1% cyclopentolate at 15-minute intervals. The mean difference between noncycloplegic and cycloplegic refraction was compared between the two regimens. RESULTS: A total of 308 eyes of 308 hyperopic children were included. The mean difference (±standard deviation) in the spherical equivalent (SE) between cycloplegic and noncycloplegic refraction was significantly larger in regimen 2 than in regimen 1, with values of +1.70 ± 1.03 diopters (D) and +1.25 ± 0.89 D, respectively (p=0.001). The SE change after cycloplegia was significantly different between the two regimens only in patients aged 5 years or younger (p=0.001), particularly in those with high hyperopia with an SE ≥5 D (p=0.005) or fully accommodative esotropia (p=0.009). There was no significant difference between the two regimens in patients older than 5 years, regardless of the presence of high hyperopia or fully accommodative esotropia. CONCLUSIONS: The Tropherine-added regimen exerted a weaker cycloplegic effect than the cyclopentolate-only regimen, particularly in children under the age of 5 years with high hyperopia or fully accommodative esotropia. However, the difference in refraction between the two regimens was small. A Tropherine-added regimen can be effective in hyperopic children, with less associated discomfort than the instillation of cyclopentolate.
Child* ; Cyclopentolate* ; Esotropia ; Humans ; Hyperopia ; Medical Records ; Phenylephrine* ; Retinoscopy ; Retrospective Studies ; Tropicamide*

Computer adaptive testing (CAT) is a kind of tailored testing, in that it is a form of computer-based testing that is adaptive to each test-taker's ability level. In this review, the impacts of CAT are discussed from different perspectives in order to illustrate crucial points to keep in mind during the development and implementation of CAT. Test developers and psychometricians often emphasize the efficiency and accuracy of CAT in comparison to traditional linear tests. However, many test-takers report feeling discouraged after taking CATs, and this feeling can reduce learning self-efficacy and motivation. A trade-off must be made between the psychological experiences of test-takers and measurement efficiency. From the perspective of educators and subject matter experts, nonstatistical specifications, such as content coverage, content balance, and form length are major concerns. Thus, accreditation bodies may be faced with a discrepancy between the perspectives of psychometricians and those of subject matter experts. In order to improve test-takers' impressions of CAT, the author proposes increasing the target probability of answering correctly in the item selection algorithm even if doing so consequently decreases measurement efficiency. Two different methods, CAT with a shadow test approach and computerized multistage testing, have been developed in order to ensure the satisfaction of subject matter experts. In the shadow test approach, a full-length test is assembled that meets the constraints and provides maximum information at the current ability estimate, while computerized multistage testing gives subject matter experts an opportunity to review all test forms prior to administration.
Accreditation ; Animals ; Cats ; Learning ; Motivation ; Retinoscopy

PURPOSE: To evaluate the clinical usefulness, convenience, and possibility of using the medical records of fundus photography with a smartphone. METHODS: We used an ophthalmoscope to examine the images using a smartphone (iphone 6, Apple Inc., Cupertino, CA, USA) and +20D and +28D condensing lenses. Twenty-four subjects were selected for comparison with the conventional funduscopic camera. The posterior pole of the 45° range of the right eye and the fundus photograph taken using the smartphone were analyzed. We measured the distances between specific points on three photographs taken of the patient and calculated the photographing range. RESULTS: The +20 D lens was 0.80 ± 0.06 times smaller than that of the fundus camera and +1.12 ± 0.06 times bigger than that of the fundus photograph. When the area of the funduscope was converted to 45°, +20 D could visualize an area of 36.10 ± 2.82°, and +28 D could visualize a 50.56 ± 2.68° area. CONCLUSIONS: Without expensive equipment, a smart phone and a condensing lens can be used to easily perform fundus examination without the need for a special technique. Therefore, this technique is not only useful clinically, but also is very convenient for keeping medical records as fundus photographs.
Humans ; Medical Records ; Ophthalmoscopes ; Ophthalmoscopy ; Photography* ; Smartphone*

PURPOSE: We report a case of amaurosis fugax associated with ipsilateral internal carotid artery agenesis. CASE SUMMARY: A 50-year-old woman presented with amaurosis fugax in her left eye; the frequency of episodes of the condition had recently increased to once a month. She had a history of hypertension and dyslipidemia, and was under medical therapy. The visual acuity of both eyes was 20/20. Slit-lamp examination was normal except for pseudophakia. Ophthalmoscopy revealed a myopic tigroid fundus and a myopic tilted disc. No abnormalities were evident in fluorescein fundus angiography. Brain computed tomography showed that the left bony carotid canal was absent, and magnetic resonance angiography showed that the left internal carotid artery was also absent. She was diagnosed with left internal carotid artery agenesis. Other neurological and hematological parameters were within normal ranges. The amaurosis fugax spontaneously disappeared and has not recurred over the past 12 months. Our case, although rare, suggests that amaurosis fugax may be associated with internal carotid artery agenesis.
Amaurosis Fugax* ; Angiography ; Blindness* ; Brain ; Carotid Artery, Internal* ; Dyslipidemias ; Female ; Fluorescein ; Humans ; Hypertension ; Magnetic Resonance Angiography ; Middle Aged ; Ophthalmoscopy ; Pseudophakia ; Reference Values ; Visual Acuity

PURPOSE: To report cases of oil droplet cataract, one cause of decreased vision of unknown etiology. METHODS: We performed a retrospective chart review analysis of patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity and diagnosed with oil droplet cataract. Clinical features including history, result of ophthalmologic examinations, and clinical course were evaluated. RESULTS: Among the patients referred to the neuro-ophthalmology clinic due to unknown etiology of decreased visual acuity, 6 patients were diagnosed with oil droplet cataract. The patients ranged from 38 to 63 years of age and their best corrected visual acuities at their first visits were between 0.1 and 0.7. Ophthalmologic examinations including neuro-ophthalmologic tests were normal except for changes in lens nucleus and peculiar fundus reflexes were observed using retinoscopy in all patients. Five eyes of 4 patients underwent cataract surgery and all 5 eyes achieved the best corrected visual acuity of 1.0 or higher. CONCLUSIONS: Oil droplet cataract is a cause of decreased visual acuity of unknown etiology that can be missed. The disease abnormalities are difficult to observe because only subtle changes in lens nucleus are apparent on slit lamp examination; however characteristic fundus reflexes can be identified using retinoscopy. Ophthalmologists should thoroughly understand the oil droplet cataract and diagnose it in the early stages to avoid misdiagnosis and unnecessary costs.
Cataract* ; Diagnostic Errors ; Humans ; Reflex ; Retinoscopy ; Retrospective Studies ; Slit Lamp ; Visual Acuity