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: To investigate the outcomes of scleral buckling surgery performed under a slit-lamp illumination system (Visulux) with a contact wide-angle viewing lens (Mini Quad) in patients with rhegmatogenous retinal detachment (RRD) and to compare these outcomes with those of surgery performed under an indirect ophthalmoscope. METHODS: By retrospective review of electronic medical records, patients with RRD who had undergone scleral buckling surgery were identified. Scleral buckling surgeries were performed with two illumination instruments, a slit-lamp (SL group) and an indirect ophthalmoscope (IO group). Subretinal fluid drainage, cryopexy, and intravitreal gas injection were performed optionally. At 6 months after surgery, anatomical and functional outcomes were evaluated and compared between the two groups. Operation time was also compared between the two groups. RESULTS: Of the 45 total patients (45 eyes), 28 were included in the SL group, and 17 were included in the IO group. In the SL and IO groups, the primary anatomical success rate was 89.3% and 88.2%, respectively (p = 0.92). The logarithm of the minimal angle of resolution change, which reflects improvement in best-corrected visual acuity after surgery, was −0.19 ± 0.38 in the SL group and −0.21 ± 0.63 in the IO group; this difference was not statistically significant (p = 0.91). The mean operation time was significantly shorter in the SL group (78.9 ± 11.8 minutes) than in the IO group (100.0 ± 13.9 minutes, p < 0.001), especially for patients who underwent additional procedures such as subretinal fluid drainage and cryopexy (81.4 ± 12.9 and 103.5 ± 12.3 minutes, respectively, p < 0.001). CONCLUSIONS: Scleral buckling surgery performed under a slit-lamp illumination system yielded a similar anatomical success rate and similar functional improvement in RRD compared with surgery performed under an indirect ophthalmoscope. The slit-lamp system could save time, especially in bullous RRD, which requires additional subretinal fluid drainage.
Drainage ; Electronic Health Records ; Humans ; Jupiter ; Lighting* ; Ophthalmoscopes* ; Retinal Detachment ; Retrospective Studies ; Scleral Buckling* ; Slit Lamp ; Subretinal Fluid ; Visual Acuity

PURPOSE: To report the outcome of scleral buckling using a non-contact wide-angle viewing system with a 25-gauge chandelier endoilluminator. METHODS: Retrospective analyses of medical records were performed for 17 eyes of 16 patients with primary rhegmatogenous retinal detachment (RRD) without proliferative vitreoretinopathy who had undergone conventional scleral buckling with cryoretinopexy using the combination of a non-contact wide-angle viewing system and chandelier endoillumination. RESULTS: The patients were eight males and five females with a mean age of 26.8 ± 10.2 (range, 11 to 47) years. The mean follow-up period was 7.3 ± 3.1 months. Baseline best-corrected visual acuity was 0.23 ± 0.28 logarithm of the minimum angle of resolution units. Best-corrected visual acuity at the final visit showed improvement (0.20 ± 0.25 logarithm of the minimum angle of resolution units), but the improvement was not statistically significant (p = 0.722). As a surgery-related complication, there was vitreous loss at the end of surgery in one eye. As a postoperative complication, increased intraocular pressure (four cases) and herpes simplex epithelial keratitis (one case) were controlled postoperatively with eye drops. One case of persistent RRD after primary surgery needed additional vitrectomy, and the retina was postoperatively attached. CONCLUSIONS: Scleral buckling with chandelier illumination as a surgical technique for RRD has the advantages of relieving the surgeon's neck pain from prolonged use of the indirect ophthalmoscope and sharing the surgical procedure with another surgical team member. In addition, fine retinal breaks that are hard to identify using an indirect ophthalmoscope can be easily found under the microscope by direct endoillumination.
Female ; Follow-Up Studies ; Herpes Simplex ; Humans ; Intraocular Pressure ; Keratitis ; Lighting ; Male ; Medical Records ; Neck Pain ; Ophthalmic Solutions ; Ophthalmoscopes ; Postoperative Complications ; Retina ; Retinal Detachment ; Retinal Perforations ; Retrospective Studies ; Scleral Buckling* ; Visual Acuity ; Vitrectomy ; Vitreoretinopathy, Proliferative

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 3 cases of patients with retinal hemorrhage among 27 newborns with intrauterine growth retardation. CASE SUMMARY: Twenty-seven newborns with intrauterine growth retardation were examined using the indirect ophthalmoscope for confirming retinal hemorrhage which was observed in 3 patients. The mean gestational age and birth weight (g) of the 3 patients were 37⁺⁶ weeks and 2,086.7 g, respectively. Among the 3 newborns, 1 patient's mother had oligohydramnios. Two patients were delivered vaginally and 1 by cesarean section. All 3 patients had no birth trauma and the retinal hemorrhage was resolved within 2 weeks after the first eye examination. CONCLUSIONS: We observed 3 cases with retinal hemorrhage in neonates with intrauterine growth retardation which improved within 2 weeks.
Birth Weight ; Cesarean Section ; Female ; Fetal Growth Retardation ; Gestational Age ; Humans ; Incidence* ; Infant, Newborn* ; Korea* ; Mothers ; Oligohydramnios ; Ophthalmoscopes ; Parturition ; Pregnancy ; Retinal Hemorrhage* ; Retinaldehyde*

PURPOSE: To evaluate the performance of the hand-held and table-top autorefractokeratometer in measuring refractive errors by comparing them with cycloplegic retinoscopy. METHODS: Included in the study were 112 eyes of 112 pediatric patients whose mean age was 6.78 +/- 2.61 years (range, 2 to 12 years). The refractive errors of all the eyes were measured with and without cycloplegia using a hand held autorefractokeratometer (Retinomax K-plus 3), table top autorefractokeratometer (Canon RK-F1) and performing cycloplegic retinoscopy. The spherical equivalent, cylindrical axis and keratometer values were statistically compared. RESULTS: The mean spherical equivalent obtained from the Retinomax K-plus 3 was significantly less hyperopic than that of Canon RK-F1 (p = 0.004) before cycloplegia. When the Bland Altman analysis was performed in comparisons of spherical equivalent values measured with the Retinomax K-plus 3, Canon RK-F1 and cycloplegic retinoscopy, it was seen that almost all of the differences between the measurements remained within the range of +/-2 standard deviation. Good agreement was found between Retinomax K-plus 3 and Canon RK-F1 for the Jackson cross-cylinder values at axis 0degrees and 45degrees; keratometer values respectively. CONCLUSIONS: The refractive error components were highly correlated between the two instruments and cycloplegic retinoscopy.
Child ; Child, Preschool ; Female ; Humans ; Male ; Refractive Errors/*diagnosis ; *Retinoscopes ; *Retinoscopy ; Vision Screening

PURPOSE: To evaluate the performance of the hand-held and table-top autorefractokeratometer in measuring refractive errors by comparing them with cycloplegic retinoscopy. METHODS: Included in the study were 112 eyes of 112 pediatric patients whose mean age was 6.78 +/- 2.61 years (range, 2 to 12 years). The refractive errors of all the eyes were measured with and without cycloplegia using a hand held autorefractokeratometer (Retinomax K-plus 3), table top autorefractokeratometer (Canon RK-F1) and performing cycloplegic retinoscopy. The spherical equivalent, cylindrical axis and keratometer values were statistically compared. RESULTS: The mean spherical equivalent obtained from the Retinomax K-plus 3 was significantly less hyperopic than that of Canon RK-F1 (p = 0.004) before cycloplegia. When the Bland Altman analysis was performed in comparisons of spherical equivalent values measured with the Retinomax K-plus 3, Canon RK-F1 and cycloplegic retinoscopy, it was seen that almost all of the differences between the measurements remained within the range of +/-2 standard deviation. Good agreement was found between Retinomax K-plus 3 and Canon RK-F1 for the Jackson cross-cylinder values at axis 0degrees and 45degrees; keratometer values respectively. CONCLUSIONS: The refractive error components were highly correlated between the two instruments and cycloplegic retinoscopy.
Child ; Child, Preschool ; Female ; Humans ; Male ; Refractive Errors/*diagnosis ; *Retinoscopes ; *Retinoscopy ; Vision Screening

PURPOSE: To evaluate various types and; characteristics of non-retinal lesions associated with ultra-wide field scanning laser ophthalmoscope images. METHODS: This retrospective study included 139 eyes of 139 patients with non-retinal lesions observed on color images obtained using Optomap 200Tx (Optos PLC, Dunfermline, Scotland, UK). The non-retinal lesion is a hyperreflective or hyporeflective shadow due to anterior segment of the eye or vitreous except the retina. Types and characteristics of red laser separation, green laser separation and autofluorescence images of non-retinal lesions were evaluated. RESULTS: All non-retinal lesions in images were categorized into 2 groups according to the location of non-retinal lesions. The anterior non-retinal lesions group included corneal opacity, cataract and posterior capsular opacity. The posterior non-retinal lesions group included asteroid hyalosis, posterior vitreous detachment, vitreous opacity and vitreous hemorrhage. Anterior non-retinal lesions were more often hyporeflective in red and green laser separation images (p < 0.001). Posterior non-retinal lesions were more often hyperreflective in green laser separation images and hyporeflective in red laser separation images (p < 0.001). CONCLUSIONS: Ultra-wide field scanning laser ophthalmoscope images can frequently have various shadows from anterior or posterior lesions of the eye. These shadows show a difference in reflectivity depending on their origins. To understand the difference helps in the interpretation of the fundus images.
Cataract ; Corneal Opacity ; Humans ; Ophthalmoscopes* ; Retina ; Retrospective Studies ; Scotland ; Vitreous Detachment ; Vitreous Hemorrhage

PURPOSE: We evaluated the progression of geographic atrophy (GA) based on fundus autofluorescence (FAF) pattern and atrophy size using the fundus camera in non-exudative age-related macular degeneration (ARMD). METHODS: We acquired FAF images in non-exudative ARMD patients over a 2-year period. According to The Fundus Autofluorescence in Age-related Macular Degeneration (FAM) study, FAF patterns of geographic atrophy were classified into 5 categories. Examiners quantified the areas of GA in FAF images and analyzed the progression of atrophy based on FAF pattern and atrophy size. RESULTS: In 86 non-exudative ARMD eyes, elderly patients had faster progression rate of GA. The growth rates of GA were 1.51 mm2/year in 'Diffuse', 1.49 mm2/year in 'Banded', 1.05 mm2/year in 'Patchy', 0.59 mm2/year in 'Focal' and 0.16 mm2/year in 'None' pattern groups. In addition, the growth rate was 0.38 mm2/year in which initial the GA area was smaller than 1 disc area. This was the slowest progression rate among all categories according to initial GA area. CONCLUSIONS: As a result of evaluating the progression of geographic atrophy using FAF over a 2-year period, the growth rate of GA was the fastest in the 'Diffuse' pattern group. Additionally, as the initial GA area became smaller, the progression of GA atrophy was slower (p < 0.002). Although limitations such as short follow-up period and measurement error of GA atrophy area using fundus photography were compensated, the results in the present study were similar to the outcomes of studies on progression of GA based on FAF pattern using the scanning laser ophthalmoscope over several years and the fundus camera for 1 year. In conclusion, the fundus camera is a useful tool for the prediction of long-term progression of GA in patients with non-exudative ARMD.
Aged ; Atrophy ; Follow-Up Studies* ; Geographic Atrophy* ; Humans ; Macular Degeneration ; Ophthalmoscopes ; Photography

PURPOSE: To investigate identifiable peripheral retinal lesions in patients with myopia or high myopia and to evaluate the usefulness of ultra-widefield scanning laser ophthalmoscope in retina clinic settings. METHODS: We evaluated fundus images of 149 patients acquired using an ultra-widefield scanning laser ophthalmoscope. Manual fundus examination by a retinal specialist was performed and sensitivity and specificity were calculated by comparing the findings of the two different fundus examination methods. RESULTS: Variable peripheral retinal lesions were observed: lattice degeneration (24.1% in myopia, 36.6% in high myopia), white without pressure (17.7% in myopia, 20.7% in high myopia), retinal break (5.1% in myopia, 7.5% in high myopia) and retinal detachment (1.3% in myopia, 4.2% in high myopia). The incidence of lattice degeneration was significantly higher in myopic eyes than in highly myopic eyes (p = 0.043). The examination sensitivities were as follows: lattice degeneration (84.2% in myopia, 91.0% in high myopia), white without pressure (100.0% in both myopia and high myopia), retinal break (75.0% in myopia, 43.8% in high myopia) and retinal detachment (100.0% in myopia, 66.7% in high myopia). The examination specificities were 100.0% in all cases. CONCLUSIONS: Diagnostic sensitivities of ultra-widefield scanning laser ophthalmoscope were 90.8% in patients with myopia, 91.0% in patients with high myopia and 90.9% in totally myopic patients, which were relatively high values. Therefore, the ultra- widefield scanning laser ophthalmoscope is useful as auxiliary equipment for myopic patients in retina clinic settings.
Humans ; Incidence ; Myopia ; Ophthalmoscopes* ; Retina ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde* ; Sensitivity and Specificity ; Specialization