Academic literature on the topic 'Dilated eye exams'
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Journal articles on the topic "Dilated eye exams"
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Zhang, Wenlan, Peter Nicholas, Stefanie Gail Schuman, Michael John Allingham, Ambar Faridi, Tushar Suthar, Scott William Cousins, and Sasapin Grace Prakalapakorn. "Screening for Diabetic Retinopathy Using a Portable, Noncontact, Nonmydriatic Handheld Retinal Camera." Journal of Diabetes Science and Technology 11, no. 1 (July 11, 2016): 128–34. http://dx.doi.org/10.1177/1932296816658902.
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Background: Diabetic retinopathy (DR) is a leading cause of low vision and blindness. We evaluated the feasibility of using a handheld, noncontact digital retinal camera, Pictor, to obtain retinal images in dilated and undilated eyes for DR screening. We also evaluated the accuracy of ophthalmologists with different levels of training/experience in grading these images to identify eyes with vision-threatening DR. Methods: A prospective study of diabetic adults scheduled to have dilated eye exams at Duke Eye Center from January to May 2014 was conducted. An imager acquired retinal images pre- and postdilation with Pictor and selected 1 pre- and 1 postdilation image per eye. Five masked ophthalmologists graded images for gradability (based on image focus and centration) and the presence of no, mild, moderate, or severe nonproliferative DR (NPDR) or proliferative DR (PDR). Referable disease was defined as moderate or severe NPDR or PDR on image grading. We evaluated feasibility based on the graders’ evaluation of image gradability. We evaluated accuracy of identifying vision-threatening disease (severe NPDR or PDR documented on dilated clinical examination) based on the graders’ sensitivity and specificity of grading referable disease. Results: Images were gradable in 86-94% of predilation and 94-97% of postdilation photos. Compared to the dilated clinical exam, overall sensitivity for identifying vision-threatening DR was 64-88% and specificity was 71-90%. Conclusions: Pictor can capture retinal images of sufficient quality to screen for DR with and without dilation. Single retinal images obtained using Pictor can identify eyes with vision-threatening DR with high sensitivity and acceptable specificity compared to clinical exam.
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Lee, Bonny, Lydia Breskin, Laya Reddy, Alessandro Iliceto, Deborah Ashcraft, George Pankey, Jonathan Nussdorf, and Julia Garcia-Diaz. "Ocular Candidiasis in Patients with Candidemia at a Large Tertiary Care Center." Open Forum Infectious Diseases 4, suppl_1 (2017): S85. http://dx.doi.org/10.1093/ofid/ofx163.034.
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Abstract Background Bloodstream infections (BSI) caused by Candida sp. have a high mortality rate and have been increasing in recent years. Ocular candidiasis (OC) is one systemic manifestation of Candida infection; either chorioretinitis or endophthalmitis, and may lead to vision loss. Therefore, IDSA recommends an ophthalmology exam for all patients with Candida BSI. However, reported incidence of OC varies from 1 to 25%, questioning routine eye exams in these patients. The purpose of this study was to evaluate the number of patients who undergo ophthalmological exams and those diagnosed with OC at Ochsner Medical Center, New Orleans (OMC-NO). Methods One hundred and forty-four patients were identified from January 2013 to December 2015 with at least one positive blood culture for Candida sp. (only albicans, glabrata, and parapsilosis were included). Records were reviewed through the EPIC system. Results Of the 144 patients, 65 were females and 79 males; average age 58 years old. Seventy-six (52.8%) had an ophthalmological exam at Ochsner; excluding one patient who refused an exam, one patient who was excessively combative, and one patient in whom exam was deferred due to medical condition. Three patients (3.9%) showed Candida chorioretinitis; none endophthalmitis. Conclusion OC can have devastating consequences if left untreated and early diagnosis is imperative. Our analysis reveals that OC is present in 3.9% of ophthalmology exams, but this may be biased towards patients who are cooperative and can tolerate a dilated eye exam. Critical patients with multiple co-morbidities may be at higher risk for OC. A weakness of our study is that it is limited to ophthalmology records at Ochsner, and there may be records at outside facilities. Further data is required to make recommendations in patients with Candida BSI. Disclosures All authors: No reported disclosures.
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Comer-HaGans, DeLawnia, Shamly Austin, Zo Ramamonjiarivelo, and Alicia K. Matthews. "Diabetes Standard of Care Among Individuals Who Have Diabetes With and Without Cognitive Limitation Disabilities." Diabetes Educator 46, no. 1 (December 24, 2019): 94–107. http://dx.doi.org/10.1177/0145721719896262.
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Purpose The purpose of this study is to examine diabetes standard of care among individuals who have diabetes with and without cognitive limitation disabilities (CLDs). Individuals with CLDs are more likely to develop diabetes and less likely to participate in diabetes standard of care services compared to those without CLDs. Methods We used pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS). Dependent variables were utilization of dilated eye exams, foot checks, A1C blood tests, and engagement in moderate or vigorous physical exercise 5 times per week. Our independent variable was diabetes with CLDs vs diabetes without CLDs. We controlled for predisposing, enabling, and need factors. Results Findings suggest that individuals with diabetes and CLDs were less likely to engage in moderate or vigorous physical exercise 5 times per week compared to individuals without CLDs. For other diabetes care services, individuals with CLDs are as likely to participate in health services utilization as those without CLDs. Conclusions Our study supports research that indicates individuals with diabetes and CLDs were less likely to participate in physical exercise compared to individuals without CLDs. Conversely, individuals with diabetes and CLDs were just as likely to receive a dilated eye exam, have their feet checked, and have their A1C checked as individuals without CLDs, which is a very encouraging finding.
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Paulson, Chase, Samuel C. Thomas, Orlando Gonzalez, Samuel Taylor, Cole Swiston, Jennifer S. Herrick, Lori McCoy, et al. "Exfoliation Syndrome in Baja Verapaz Guatemala: A Cross-Sectional Study and Review of the Literature." Journal of Clinical Medicine 11, no. 7 (March 24, 2022): 1795. http://dx.doi.org/10.3390/jcm11071795.
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There are little epidemiologic data on exfoliation syndrome (XFS) or exfoliation glaucoma (XFG) in Guatemala, especially in the underserved Baja Verapaz region. This observational study assessing XFS/XFG and demographic factors of this region aims to better understand unique exogenous and endogenous risk factors associated with XFS/XFG in Guatemala. During Moran Eye Center’s global outreach medical eye camps from 2016–2017, 181 patients age 15 years and older presented for complete eye exams. These individuals were screened for eye disease and evaluated for possible surgical interventions that could occur during the camps to improve eyesight. During the dilated exams, XFS was noted as missing or present. Of those 181, 10 had insufficient data and 18 lacked a definitive diagnosis of XFS or XFG, resulting in 153 evaluable patients; 46 XFS and 9 XFG were identified. Age, gender, hometown, ancestry (languages spoken by parents and grandparents), past medical history, family medical history, and occupational data (only 2017 trip) were obtained for each patient. The most common occupations of these individuals were farming and housekeeping. Higher rates of XFS/XFG were noted in individuals of rural compared to urban settings and Mayan speaking people compared with Spanish speakers. Based on this subset of patients, with various ocular pathologies being evaluated during medical eye outreach camps, the prevalence of XFS/XFG appeared to be 36%, a high prevalence compared to other world populations. Location and higher altitude, along with a farming occupation, may contribute to XFS development and subsequent progression to XFG. To our knowledge, this is the largest study looking at the epidemiology of XFS/XFG in the Baja Verapaz region of Guatemala for those over the age of 15 years seeking eye exams and interventions.
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Arslan-Carlon, Vittoria, Maria C. Walline, Kenneth Seier, Kay See Tan, and David H. Abramson. "Hemodynamic Changes Associated with Mydriatic Eye Drop Administration in Anesthetized Pediatric Patients." Ocular Oncology and Pathology 6, no. 3 (October 30, 2019): 203–9. http://dx.doi.org/10.1159/000500593.
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Background: Dilating eye drops are routinely used in pediatric retinoblastoma patients during anesthetized ophthalmologic exams. Information on the systemic effects of ocular mydriatics, especially in anesthetized pediatric patients, is limited. Objective: The primary aim of this study was to analyze hemodynamic changes during mydriatic eye drop administration in anesthetized pediatric patients. Methods: A retrospective chart review was performed for pediatric retinoblastoma patients who underwent MRI with anesthesia. Baseline blood pressure (BP) and heart rate (HR) were charted for each patient at induction. HR and mean arterial pressure (MAP) measurements were recorded at 5, 10, 15, 30, and 45 min after eye drop administration. Secondarily, we included data from 15 patients who received dilating eye drops while under sevoflurane general anesthetic. All patients were dilated with phenylephrine 2.5 or 10% (depending on age) and tropicamide 1%. Results: The final analysis included 176 anesthesia encounters. The results demonstrate no statistically significant deviation of more than 20% from baseline for either HR or MAP. Additionally, we did not detect any difference between patients who were anesthetized with propofol versus sevoflurane. Conclusions: We did not observe significant hemodynamic instability with administration of dilating eye drops during propofol anesthesia.
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Winters, David, Robin Casten, Barry Rovner, Ann Murchison, Benjamin E. Leiby, Julia A. Haller, Lisa Hark, David M. Weiss, and Laura T. Pizzi. "Cost-Effectiveness of Behavior Activation Versus Supportive Therapy on Adherence to Eye Exams in Older African Americans With Diabetes." American Journal of Medical Quality 32, no. 6 (November 24, 2016): 661–67. http://dx.doi.org/10.1177/1062860616680290.
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Although the importance of ophthalmologic screening in diabetic patients is widely recognized by clinicians, the cost-effectiveness of strategies aimed at improving eye care utilization in this population is not well established. A cost-effectiveness analysis was performed comparing behavior activation (BA) to supportive therapy (ST) in activating patients to receive a dilated fundus exam (DFE) and promoting healthy management of diabetes. Two hundred six subjects were randomized to receive either BA or ST between 2009 and 2013. Cost-effectiveness was calculated as incremental cost-effectiveness ratio (ICER) of BA versus ST. Total costs for BA and ST per participant were $259.02 and $216.12, respectively. At the 6-month follow-up, 87.91% of BA subjects received a DFE compared to 34.48% of ST subjects. The ICER for BA versus ST was $80.29/percent increase in DFE rate. In terms of improving DFE rates, BA was found to be more cost-effective than ST.
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Comer-HaGans, DeLawnia, Shamly Austin, Zo Ramamonjiarivelo, and Ledric D. Sherman. "Diabetes Self-Management Among Individuals With Diabetes and Physical Disabilities." Science of Diabetes Self-Management and Care 47, no. 4 (August 2021): 264–78. http://dx.doi.org/10.1177/26350106211024136.
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Purpose The purpose of this study was to examine diabetes self-management behavior among individuals who have diabetes living with and without physical limitations. Methods Pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey was used. Dependent variables were utilization of dilated eye exams, foot checks, at least 1 dental checkup annually, treating diabetes with oral medication, treating diabetes with insulin injections, and engagement in moderate or vigorous physical exercise 5 times per week. The independent variable was diabetes with physical limitations compared with diabetes without physical limitations. The study controlled for predisposing, enabling, and need factors. Results Findings indicate that individuals with diabetes and physical limitations were less likely to engage in moderate or vigorous physical exercise 5 times per week, have at least 1 annual dental checkup, and treat their diabetes orally with medication. Conclusions Self-management behavior was poor among individuals with diabetes and physical limitations. Environmental barriers may partially contribute to reasons why individuals with diabetes and physical limitations do not engage in diabetes self-management behaviors that would assist them in mitigating diabetes complications. Other reasons could be the lack of equipment accessibility or adaptability and cultural competence among providers treating/caring for individuals with physical limitations.
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Speckert, Matthew, Andrei-Alexandru Szigiato, Jeanne zielonka, Kathleen Hollamby, Eugene Ng, Filiberto Altomare, Michael Sgro, and Rosane Nisenbaum. "THE EFFECT OF EYEMASKS ON REDUCING DISTRESS ASSOCIATED WITH THE RETINOPATHY OF PREMATURITY EXAM." Paediatrics & Child Health 23, suppl_1 (May 18, 2018): e24-e24. http://dx.doi.org/10.1093/pch/pxy054.060.
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Abstract BACKGROUND Retinopathy of prematurity (ROP) is a disorder of retinal development in the low birthweight preterm infant. Eye screening is routinely performed for infants at risk of developing this disorder. While these examinations help prevent blindness, they can be physiologically stressful for infants, with changes in oxygen saturation, blood pressure and heart rate occurring during the exam and increased apneic episodes reported the 24–48 hours period afterward. The cause of these increased apneic episodes is not currently known. OBJECTIVES To evaluate the effect of decreasing light simulation during mydriasis on the frequency of stressful episodes after ROP screening. DESIGN/METHODS Multi-centre randomized study. This study was approved by hospital ethics boards at all sites. After informed consent was obtained, infants with a birthweight <1500g or gestational age of ≤32 weeks and scheduled for their first ROP screening were randomized to receive either standard of care or a phototherapy mask during pupil dilation, in addition to routine care. Dilated retinal exams were performed by retinal surgeons and fellows. The primary outcome was the frequency of any desaturation, bradycardic event, or apneic event 12 hours following the examination, compared to a baseline rate 12 hours prior to the exam. Heart rate, respiratory rate and oxygen saturation were recorded for up to 48 hours following the examination and compared to baseline. RESULTS A total of 51 infants were enrolled; 28 randomized to the masked group and 23 to the control group. 10 and 13 infants were on ventilator support at the time of examination in each group, respectively. There was a 57.7% decrease in the total number of all stressful events in the masked group compared to controls in the 12 hour post exam period (Rate Ratio 0.42, 95% CI 0.2–0.9, P=0.024). There was a 61.3% decrease in the number of bradycardic events in the masked group compared to controls (RR 0.39, 95% CI 0.2–1.0, P=0.042). Heart rate was significantly higher in both groups after the exam (Effect by time P=0.04), with no difference in between groups (Effect by group P=0.31). There was no significant difference seen in either group in respiratory rate or oxygen saturation at 2 or 4 hours after the ROP examination compared to baseline. Risk factors that were associated with increased stress included: younger gestational age (RR=1.32 95%CI [1.2–1.5] per week), lower birthweight (RR=1.39 [1.2–1.5] per 100g), ventilator support around the time of exam (RR=2.67 [1.3–5.6]), diagnosis of intraventricular hemorrhage (RR=3.78 [1.9–7.3]), and hyponatremia (RR=3.42 [1.8–6.6]). No adverse events occurred while using eye masks. CONCLUSION The infants who wore a phototherapy mask during pupillary dilation had lower rates of stressful episodes following screening for retinopathy of prematurity, particularly lower episodes of bradycardia.
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Miller, Stephania T., Jennifer Cunningham-Erves, and Sylvie A. Akohoue. "Diabetes Education, Specialty Care, and Self-Care Advice among Obese African American Women with Type 2 Diabetes." Ethnicity & Disease 26, no. 2 (April 20, 2016): 229. http://dx.doi.org/10.18865/ed.26.2.229.
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<p><strong>Objective</strong>: Healthy People 2020 (HP2020) includes benchmarks for diabetes management. The objective of our study was to describe diabetes management among African American women, a patient group that carries a disproportionate diabetes burden.</p><p><strong>Design:</strong> Cross-sectional survey study.</p><p><strong>Participants:</strong> African American women with type 2 diabetes enrolled in dietary and weight management interventions.</p><p><strong>Main Outcome Measures:</strong> Self-report assessments of diabetes education, specialty care, self-care behaviors and advice. Associations between diabetes self-care behaviors and diabetes advice using Chi-square tests.</p><p><strong>Results:</strong> Among 96 participants (age = 53 ± 9.4; BMI = 37.9 ± 7.3 kg/m2), reported diabetes education and foot exams were lower than HP2020 benchmarks, 48.9% vs 62.5% and 35.1% vs 74.8%, respectively and higher for dilated eye exams (70.1% vs 58.7%). The most frequently reported dietary advice was to increase fruit/ vegetable intake (58%) and approximately 50% reported physical activity advice. Receiving no exercise advice was associated with greater odds of little or no physical activity (OR = 3.38) and planned exercises (OR = 2.65).</p><p><strong>Conclusion:</strong> Receipt of diabetes education and some specialty care were below national benchmarks while health care provider advice influenced patient self-care behaviors. Increasing diabetes education and specialty care should be included within existing efforts to address the excess diabetes burden experienced by African American women. Longitudinal studies exploring the relationship between health care provider advice and self-care behaviors are needed. <em>Ethn Dis.</em> 2016;26(2):229-234; doi:10.18865/ed.26.2.229</p>
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Corrao, Giovanni, Federico Rea, Mirko Di Martino, Adele Lallo, Marina Davoli, Rossana DlE PlALMA, Laura Belotti, et al. "Effectiveness of adherence to recommended clinical examinations of diabetic patients in preventing diabetes-related hospitalizations." International Journal for Quality in Health Care 31, no. 6 (July 1, 2019): 464–72. http://dx.doi.org/10.1093/intqhc/mzy186.
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Abstract Objective To validate a set of indicators for quality of diabetes care through their relationship with measurable clinical outcomes. Design A retrospective cohort study was carried out from 2010 to 2015. Setting Population-based study. Data were retrieved from healthcare utilization databases of three Italian regions (Lombardy, Emilia Romagna and Lazio) on the whole covering 20 million citizens. Participants The 77 285 individuals who were newly taken in care for diabetes during 2010 entered into the cohort. Interventions Exposure to selected clinical recommendations (i.e. periodic controls for glycated hemoglobin, lipid profile, urine albumin excretion, serum creatinine and dilated eye exams) was recorded. Main outcomes measures A composite outcome was employed taking into account hospitalizations for brief-term diabetes complications, uncontrolled diabetes, long-term vascular outcomes and no traumatic lower limb amputation. A multivariable proportional hazards model was fitted to estimate hazard ratio, and 95% confidence intervals (CI), for the exposure-outcome association. Results Among the newly taken in care patients with diabetes, those who adhered to almost none (0 or 1), just some (2 or 3) or almost all (4 or 5) recommendations during the first year after diagnosis were 44%, 36% and 20%, respectively. Compared patients who adhered to almost none recommendation, significant risk reductions of 16% (95% CI, 6–24%) and 20% (7–28%) were observed for those who adhered to just some and almost all recommendations, respectively. Conclusions Tight control of patients with diabetes through regular clinical examinations must to be considered the cornerstone of national guidance, national audits and quality improvement incentives schemes.