Feasibility of the Digital Retinography System Camera in the Pediatric Emergency Department

Ivan, Yaron; Ramgopal, Sriram; Winger, Daniel G.; Wang, Li; Vitale, Melissa; Saladino, Richard A.

doi:10.1097/pec.0000000000001203

Cited by 14 publications

(9 citation statements)

References 7 publications

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“…Although access to fundus photographs improved the ED providers' detection rate of relevant funduscopic abnormalities from 0% with direct ophthalmoscopy to 46% on fundus photographs, 6 further image‐interpretation training of the ED providers did not substantially improve their performance 7 . Several additional studies have confirmed that ophthalmoscopy can be replaced by ocular fundus digital cameras that rapidly and easily provide high‐quality fundus photographs of the optic nerve and retina, even without pharmacologic dilation of the pupils 1,8–11 …”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies based primarily in emergency departments (EDs) and outpatient clinics have shown that most nonophthalmologic health care providers are not able to reliably examine the ocular fundus 3–5 . Recent publications have emphasized that nonmydriatic ocular fundus photography can easily replace ophthalmoscopy in EDs and urgent care centers, as well as in neurologic and other adult and pediatric clinics 6–11 . These ocular fundus photographs can be interpreted on site or remotely by ophthalmologists via telemedicine 1,11 .…”

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confidence: 99%

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Optic Disc Classification by Deep Learning versus Expert Neuro‐Ophthalmologists

Biousse¹,

Newman²,

Najjar³

et al. 2020

Annals of Neurology

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and for the BONSAI (Brain and Optic Nerve Study with Artificial Intelligence) Study Group Objective: To compare the diagnostic performance of an artificial intelligence deep learning system with that of expert neuro-ophthalmologists in classifying optic disc appearance. Methods: The deep learning system was previously trained and validated on 14,341 ocular fundus photographs from 19 international centers. The performance of the system was evaluated on 800 new fundus photographs (400 normal optic discs, 201 papilledema [disc edema from elevated intracranial pressure], 199 other optic disc abnormalities) and compared with that of 2 expert neuro-ophthalmologists who independently reviewed the same randomly presented images without clinical information. Area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were calculated. Results: The system correctly classified 678 of 800 (84.7%) photographs, compared with 675 of 800 (84.4%) for Expert 1 and 641 of 800 (80.1%) for Expert 2. The system yielded areas under the receiver operating characteristic curve of 0.97 (95% confidence interval [CI] = 0.96-0.98), 0.96 (95% CI = 0.94-0.97), and 0.89 (95% CI = 0.87-0.92) for the detection of normal discs, papilledema, and other disc abnormalities, respectively. The accuracy, sensitivity, and specificity of the system's classification of optic discs were similar to or better than the 2 experts. Intergrader agreement at the eye level was 0.71 (95% CI = 0.67-0.76) between Expert 1 and Expert 2, 0.72 (95% CI = 0.68-0.76) between the system and Expert 1, and 0.65 (95% CI = 0.61-0.70) between the system and Expert 2. Interpretation: The performance of this deep learning system at classifying optic disc abnormalities was at least as good as 2 expert neuro-ophthalmologists. Future prospective studies are needed to validate this system as a diagnostic aid in relevant clinical settings.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Optic Disc Classification by Deep Learning versus Expert Neuro‐Ophthalmologists

Biousse¹,

Newman²,

Najjar³

et al. 2020

Annals of Neurology

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“…Additionally, the average length of time to obtain the image was 1.8 minutes and the average patient cooperation was rated as 4.4 out of 5 (1 ¼ uncooperative, no images obtained and 5 ¼ very cooperative). 19 Cost, patient satisfaction, and length of stay could all potentially be improved by utilization of such devices.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Incidence of Inpatient Ophthalmology Consultations to Screen for Papilledema

et al. 2019

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Objective A frequent reason for ophthalmology consultation is to rule out papilledema. The purpose of this study is to evaluate the incidence of consultations to screen for papilledema in an acute inpatient setting and determine the frequency and factors associated with a positive diagnosis of bilateral optic nerve swelling. Methods A retrospective chart review was performed of consecutive adult and pediatric inpatient ophthalmology consultations at a tertiary hospital system to “rule out papilledema” from September through November 2016. All patients had a detailed neuro-ophthalmology examination including a dilated fundus exam. Results A total of 36 consults—13 males and 23 females—with a mean age of 19.8 (range: 3–71) years were called to screen for papilledema. The most common service to request the consult was pediatrics (44%), followed by neurosurgery (42%), medicine (8%), and neurology (6%). The most frequent reason for consultation was headache (61%), followed by visual changes (30.5%) and nausea/vomiting (25%). A positive diagnosis of bilateral optic nerve swelling occurred in 14% (5/36) of consults. Of these five consults, four of them were sent into the hospital by an ophthalmologist who noted the bilateral optic nerve swelling and one was noted by an emergency room pediatrician. Conclusion No new cases of bilateral optic nerve swelling were found in screening consults to “rule out papilledema.” All of the positive diagnoses in our study had been previously identified by another physician and known to the primary team prior to ophthalmology consultation. Screening consultations for optic nerve swelling may not be an effective way to rule out papilledema.

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“…48,49 Numerous other studies have now validated the use of cameras in clinical settings other than adult EDs. [50][51][52][53][54] The feasibility and reliability of nonmydriatic fundus photography in children as young as 22 months was demonstrated in a pediatric ophthalmology clinic. 50 A subsequent study validated the use of a tabletop nonmydriatic camera in children ages 5-12 years in a pediatric ED.…”

Section: Future Applicationsmentioning

confidence: 99%

“…50 A subsequent study validated the use of a tabletop nonmydriatic camera in children ages 5-12 years in a pediatric ED. 51 Another study showed that relatively good images of the optic disc could be obtained in children as young as 2 years without pupillary dilation using a smartphone attached to an ophthalmoscope. 52 The applications of this technology in neurology settings are multiple and go beyond the assessment of papilledema in headache patients.…”

Section: Future Applicationsmentioning

confidence: 99%

Ophthalmoscopy in the 21st century

2018

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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 nonophthalmologists' performance of this essential part of the physical examination, thus helping to reestablish the value of doing so.

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Feasibility of the Digital Retinography System Camera in the Pediatric Emergency Department

Abstract: Our data suggest that NMOFP using the DRS camera is a rapid and easy method of obtaining high-quality images of the retina in pediatric ED patients.

Cited by 14 publications

References 7 publications

Optic Disc Classification by Deep Learning versus Expert Neuro‐Ophthalmologists

Optic Disc Classification by Deep Learning versus Expert Neuro‐Ophthalmologists

Characteristics and Incidence of Inpatient Ophthalmology Consultations to Screen for Papilledema

Ophthalmoscopy in the 21st century

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