Artigos de revistas: "Moorfield's Eye Hospital"

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Patel, H. C., N. D. Viswalingam e B. T. Goh. "Chlamydial Ocular Infection: Efficacy of Partner Notification by Patient Referral". International Journal of STD & AIDS 5, n.º 4 (julho de 1994): 244–47. http://dx.doi.org/10.1177/095646249400500403.

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Records on 254 patients with chlamydial ocular infection observed over a period of 67 months at the Moorfield's Eye Hospital were reviewed retrospectively in relation to sexual partners in the 6 months prior to diagnosis. Contactable partners were given an appointment through index patients to attend our clinic. Those unable to attend were issued contact slips, as used by the sexually transmitted disease (STD) clinics in the United Kingdom, to attend elsewhere: 175/328 (53%) of all partners were seen in our clinic: 161/218 (74%) of current regular partners compared to only 7/57 (12%) of ex-regular and 7/53 (13%) of casual partners. However, of those given appointments 175/201 (87%) attended: 161/179 (90%) of current regular, 7/14 (50%) of ex-regular and 7/8 (88%) of casual partners. Seventy of 328 (21%) of all partners were issued contact slips, of whom 47/70 (67%) were reported to have attended elsewhere. No contact slips were returned by other clinics, indicating a failure in the contact slip system. Thirty-five of 53 (66%) of casual, 22/57 (39%) of ex-regular and none of the current regular partners were untraceable. One hundred and five of 196 (54%) female partners were examined, of whom 59/105 (56%) had chlamydial genital infection, 45/105 (43%) had other genital infections and 35/105 (33%) had multiple genital infections. Seventy of 132 (53%) male partners were examined, of whom 58/70 (83%) had chlamydial or non-specific urethritis, 5/70 (7%) had other genital infections and 4/70 (6%) had multiple genital infections. Partner notification is important to interrupt chlamydia transmission. This study shows that proactive appointment-based partner notification is effective in ensuring compliance with attendance.

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Gibbs, Denis. "Moorfields Eye Hospital and the Blind Beggar Bartimaeus". Journal of Medical Biography 3, n.º 3 (agosto de 1995): 147. http://dx.doi.org/10.1177/096777209500300304.

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Grey, R. "The History of Moorfields Eye Hospital, Volume III". British Journal of Ophthalmology 89, n.º 5 (1 de maio de 2005): 645. http://dx.doi.org/10.1136/bjo.2004.057166.

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Dholakia, Seetal Savania, e Frank Larkin. "The Moorfields Keralink trial – be involved". Optician 2016, n.º 10 (outubro de 2016): 146682–1. http://dx.doi.org/10.12968/opti.2016.10.146682.

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Yule, Peter, e Peter K. Leaver. "Forty Years on: The History of Moorfields Eye Hospital, Volume 3". Health and History 7, n.º 1 (2005): 110. http://dx.doi.org/10.2307/40111520.

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Riordan-Eva, Paul. "The History of Moorfields Eye Hospital. Volume III: Forty Years On". Journal of Neuro-Ophthalmology 26, n.º 1 (março de 2006): 72–73. http://dx.doi.org/10.1097/01.wno.0000206245.27163.44.

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Wilhelmus, Kirk R. "The History of Moorfields Eye Hospital, Volume III: Forty Years On". American Journal of Ophthalmology 139, n.º 6 (junho de 2005): 1155. http://dx.doi.org/10.1016/j.ajo.2005.04.030.

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Kilduff, Caroline LS, Alice AP Thomas, Juliet Dugdill, Edward J. Casswell, Marcin Dabrowski, Claire Lovegrove, Dawn A. Sim, Gordon R. Hay e Peter BM Thomas. "Creating the Moorfields’ virtual eye casualty: video consultations to provide emergency teleophthalmology care during and beyond the COVID-19 pandemic". BMJ Health & Care Informatics 27, n.º 3 (agosto de 2020): e100179. http://dx.doi.org/10.1136/bmjhci-2020-100179.

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BackgroundThe COVID-19 crisis forced hospitals in the UK dramatically to reduce outpatient activity. To provide continuity of care and to assist patients reluctant or unable to leave their homes, video consultations were rapidly implemented across routine and emergency ophthalmology services.ObjectiveTo describe the deployment and scaling to a large volume of teleophthalmology using a video consultation platform ‘Attend Anywhere’ in Moorfields Eye Hospital’s accident and emergency (A&E) department (London, UK).MethodPatient satisfaction, waiting time, consultation duration, outcome and management were audited following the launch of the new virtual A&E service.ResultsIn the 12 days following the service launch, 331 patients were seen by video consultation. 78.6% of patients (n=260) were determined not to need hospital A&E review and were managed with advice (n=126), remote prescription (n=57), general practitioner referral (n=27), direct referral to hospital subspecialty services (n=26) or diversion to a local eye unit (n=24). Mean patient satisfaction was 4.9 of 5.0 (n=62). The mean consultation duration was 12 min (range 5–31 min) and the wait time was 6 min (range 0–37 min).ConclusionVideo consultations showed greater than expected usefulness in the remote management of eye disease and supported a substantial reduction in the number of people visiting the hospital.

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Compston, A. "Note on a reflex mechanism in the fixation of the eyeballs. By WR Gowers, MD, Assistant-Professor of Clinical Medicine in University College (London). Brain 1879: 2; 39-41 and Supranuclear palsy of eyelid closure. By RW Ross Russell. The National Hospital for Nervous Diseases, Queen Square, London WC1; St Thomas's Hospital, London SE1; Moorfield's Eye Hospital, City Road, London EC1. Brain 1980: 103; 71-82." Brain 132, n.º 2 (20 de junho de 2008): 282–84. http://dx.doi.org/10.1093/brain/awp005.

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Gore, Sri K., Nicholas P. Plowman, Aruna Dharmasena, David H. Verity e Geoffrey E. Rose. "Corneal complications after orbital radiotherapy for primary epithelial malignancies of the lacrimal gland". British Journal of Ophthalmology 102, n.º 7 (19 de outubro de 2017): 882–84. http://dx.doi.org/10.1136/bjophthalmol-2017-311134.

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PurposeTo review the long-term corneal complications after high-dose external beam orbital radiotherapy given to patients for lacrimal gland carcinomas. The impact of prophylactic measures to improve long-term ocular surface health is also assessed.DesignRetrospective case series.ParticipantsPatients under the care of Moorfields Eye Hospital and receiving external beam radiotherapy for primary epithelial lacrimal gland carcinoma between 1975 and 2014.MethodsRetrospective review of ophthalmic case notes at Moorfields Eye Hospital, and oncology and general physician records.Main outcome measuresThe occurrence of corneal perforation, and time to perforation.ResultsSixty-seven patients were included in this study, of whom nine (13%) developed corneal perforation at a median time of 10.4 months after radiotherapy (mean 35; range 3.2 months to 14.5 years); the majority (7/9; 78%) perforated within 36 months of radiotherapy. The mean follow-up interval of the whole cohort was 8.2 years (median 4.6; range, 2 months to 30.7 years).ConclusionsAlthough most patients with globe-sparing treatment of lacrimal gland carcinoma did not suffer corneal perforation, they usually require long-term therapy to maintain the ocular surface. The high-dose external beam radiotherapy needed for lacrimal gland carcinoma can produce significant ocular surface morbidity, and the 13% incidence of corneal perforation was greatest in the first 3 years after irradiation.

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Carnt, Nicole, Dana Robaei, Darwin Minnasian e John Dart. "Presentation and outcomes of Acanthamoeba Keratitis at Moorfields Eye Hospital, 1991–2012". Contact Lens and Anterior Eye 38 (fevereiro de 2015): e35. http://dx.doi.org/10.1016/j.clae.2014.11.055.

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Braendstrup, P. "Frank W. Law: The History and Traditions of the Moorfields Eye Hospital". Acta Ophthalmologica 54, n.º 6 (27 de maio de 2009): 842. http://dx.doi.org/10.1111/j.1755-3768.1976.tb01804.x.

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Errera, Marie-Hélène, e Mark Westcott. "White Dot Syndromes". European Ophthalmic Review 05, n.º 01 (2011): 78. http://dx.doi.org/10.17925/eor.2011.05.01.78.

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This article reviews the distinctive features of ‘white dot’ syndromes and related conditions. The investigations of choice for the proper diagnosis and monitoring of the diseases are indicated. A differential diagnosis is presented so that the clinician can confidently exclude other conditions such as infectious causes that can mimic white dot syndromes. This review is based upon our clinical experience in the uveitis service of Moorfields Eye Hospital, supported by an up-to-date literature review.

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Watts, G. "Moorfields Eye Hospital is to host European trial of human embryonic stem cells". BMJ 343, sep26 1 (26 de setembro de 2011): d6124. http://dx.doi.org/10.1136/bmj.d6124.

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Chang, Lydia, Ee Lin Ong, Catey Bunce, John Brookes, Maria Papadopoulos e Peng Tee Khaw. "A Review of the Medical Treatment of Pediatric Glaucomas at Moorfields Eye Hospital". Journal of Glaucoma 22, n.º 8 (2013): 601–7. http://dx.doi.org/10.1097/ijg.0b013e31824d1e2f.

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Welsh, Anne, e Jenny Wood. "Remote But Also In-House: Providing Information to Moorfields Eye Hospital and Beyond". Journal of Hospital Librarianship 9, n.º 3 (29 de julho de 2009): 318–24. http://dx.doi.org/10.1080/15323260903015699.

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Crossland, Michael. "Thirty years in the life of the Moorfields Eye Hospital Low Vision clinic". Ophthalmic and Physiological Optics 26, n.º 2 (março de 2006): 214–15. http://dx.doi.org/10.1111/j.1475-1313.2006.00402_7.x.

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Michaelides, Michel, e Gillian G. W. Adams. "Aphakic Glaucoma After Congenital Cataract Surgery at Moorfields Eye Hospital (MEH), London, UK". Journal of American Association for Pediatric Ophthalmology and Strabismus 10, n.º 1 (fevereiro de 2006): 89. http://dx.doi.org/10.1016/j.jaapos.2006.01.184.

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Jolly, Rohit, Mousindha Arjunan, Maria Theodorou e Annegret H. Dahlmann-Noor. "Eye injuries in children – incidence and outcomes: An observational study at a dedicated children’s eye casualty". European Journal of Ophthalmology 29, n.º 5 (1 de outubro de 2018): 499–503. http://dx.doi.org/10.1177/1120672118803512.

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Purpose: Trauma is an important cause of visual loss in children and may affect their quality of life. Prevention and legislation can reduce the incidence of trauma, and appropriate and timely treatment can improve prognosis. We aimed to describe incidence of eye injuries in children and the adherence to national and local management guidelines. Methods: Retrospective service evaluation at a tertiary hospital (Moorfields Eye Hospital, London, UK) which operates a dedicated children’s eye casualty. The electronic patient administration system and electronic patient record system (Openeyes) were used to identify children who presented with eye injuries between January 2015 and December 2015. Results: Of 2397 first-time attendances to our children’s casualty, 508 were for injuries (estimated incidence 21.1%, 95% confidence interval: 19.5%–22.7%). Mean age at presentation was 7.51 (standard deviation: 7.97) years; boys were more commonly affected than girls (69%). The most common injury was corneal abrasion, followed by blunt and chemical injury; severe injuries such as penetrating trauma were rare. Injuries were sustained mostly during play or sports. Two children sustained permanent loss of vision in the affected eye. Conclusion: Our findings are comparable to other published reports. Adherence to management guidelines is high, but documentation of advice given to families can be improved. Regular training of staff and collaboration with organisations outside the hospital can increase awareness of eye injuries in children.

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Samarawickrama, Chameen, Nicholas Strouthidis e Mark R. Wilkins. "Boston keratoprosthesis type 1: outcomes of the first 38 cases performed at Moorfields Eye Hospital". Eye 32, n.º 6 (14 de fevereiro de 2018): 1087–92. http://dx.doi.org/10.1038/s41433-018-0016-4.

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Nguyen, Quang, William Woof, Nathaniel Kabiri, Sagnik Sen, Malena Daich Varela, Thales Antonio Cabral De Guimaraes, Mital Shah et al. "Can artificial intelligence accelerate the diagnosis of inherited retinal diseases? Protocol for a data-only retrospective cohort study (Eye2Gene)". BMJ Open 13, n.º 3 (março de 2023): e071043. http://dx.doi.org/10.1136/bmjopen-2022-071043.

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IntroductionInherited retinal diseases (IRD) are a leading cause of visual impairment and blindness in the working age population. Mutations in over 300 genes have been found to be associated with IRDs and identifying the affected gene in patients by molecular genetic testing is the first step towards effective care and patient management. However, genetic diagnosis is currently slow, expensive and not widely accessible. The aim of the current project is to address the evidence gap in IRD diagnosis with an AI algorithm, Eye2Gene, to accelerate and democratise the IRD diagnosis service.Methods and analysisThe data-only retrospective cohort study involves a target sample size of 10 000 participants, which has been derived based on the number of participants with IRD at three leading UK eye hospitals: Moorfields Eye Hospital (MEH), Oxford University Hospital (OUH) and Liverpool University Hospital (LUH), as well as a Japanese hospital, the Tokyo Medical Centre (TMC). Eye2Gene aims to predict causative genes from retinal images of patients with a diagnosis of IRD. For this purpose, 36 most common causative IRD genes have been selected to develop a training dataset for the software to have enough examples for training and validation for detection of each gene. The Eye2Gene algorithm is composed of multiple deep convolutional neural networks, which will be trained on MEH IRD datasets, and externally validated on OUH, LUH and TMC.Ethics and disseminationThis research was approved by the IRB and the UK Health Research Authority (Research Ethics Committee reference 22/WA/0049) ‘Eye2Gene: accelerating the diagnosis of IRDs’ Integrated Research Application System (IRAS) project ID: 242050. All research adhered to the tenets of the Declaration of Helsinki. Findings will be reported in an open-access format.

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MacCallan, Michael. "Arthur Ferguson MacCallan CBE, MD, FRCS (1872–1955), trachoma pioneer and the ophthalmic campaign in Egypt 1903–1923". Journal of Medical Biography 26, n.º 1 (17 de junho de 2016): 59–67. http://dx.doi.org/10.1177/0967772016643540.

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Arthur Ferguson MacCallan was an ophthalmic surgeon who undertook his pioneering work in Egypt between 1903 and 1923. He established the Egyptian ophthalmic infrastructure which, on his departure, consisted of 23 operational hospital units, treating 134,000 new patients, having trained some 100 ophthalmic surgeons. He also established the Memorial Ophthalmic Laboratory at Giza which is still operational today. MacCallan became a world authority on trachoma. He pioneered the ‘MacCallan Classification’ which was the first grading system to standardise the stages of trachoma. He used this grading internally from 1905, continuing his research into trachoma over the ensuing years. In 1952, the WHO adopted the ‘MacCallan Classification’ as its standard. There has recently been a revival of interest in MacCallan’s work. First, the International Coalition for Trachoma Control (ICTC) inaugurated the ‘ICTC MacCallan Medal’ in 2014 as a contribution towards achieving the WHO’s target date for the Global Elimination of Blinding Trachoma (‘GET 2020’). Second, MacCallan’s work with the military hospitals has been recognised by Moorfields Eye Hospital on their World War I Commemorative History Board. Thus, MacCallan’s pioneering spirit, his humanitarian campaign for the relief of suffering and his accomplishments of over a century ago continue to resonate with the profession today.

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Din, Nizar, Maria Phylactou, Julia Fajardo-Sanchez, Martin Watson e Sajjad Ahmad. "The Impact of COVID-19 on Acute and Elective Corneal Surgery at Moorfields Eye Hospital London". Clinical Ophthalmology Volume 15 (maio de 2021): 1639–45. http://dx.doi.org/10.2147/opth.s302576.

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Narayan, Akshay, e Mariya Moosajee. "Sparse scalp hair and vision loss: think hypotrichosis with juvenile macular dystrophy". BMJ Case Reports 12, n.º 10 (outubro de 2019): e232342. http://dx.doi.org/10.1136/bcr-2019-232342.

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Here, we report the diagnostic challenge of a female patient of Russian descent with autosomal recessive hypotrichosis with juvenile macular dystrophy (HJMD). She presented to dermatology age one and a half years with sparse hair growth on her scalp, her parents were reassured this would grow, but it never manifested. She was found to be hypermetropic and prescribed glasses from age 2 but no retinal findings were noted. At age 23 years, the patient undertook an internet search and discovered the association of symptoms pointing towards HJMD. She sought genetic testing, revealing a homozygous missense mutation in Cadherin-3 (CDH3) gene. The patient presented to our Genetic Eye Disease Service at Moorfields Eye Hospital age 27 years, with reduced colour, central distance and near vision. Fundus examination and imaging confirmed atrophic macular changes. Currently, HJMD has no treatment, she wears a wig, UV-protected sunglasses in sunlight and maintains a healthy balanced diet.

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Murdoch, Ian, James Bainbridge, Paul Taylor, Lindsey Smith, Juliat Burns e Jackie Rendall. "Postoperative evaluation of patients following ophthalmic surgery". Journal of Telemedicine and Telecare 6, n.º 1_suppl (fevereiro de 2000): 84–86. http://dx.doi.org/10.1258/1357633001934258.

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We have used telemedicine to support the postoperative evaluation of patients who have had ophthalmic surgery. Mobile telemedicine workstations connected using three ISDN lines have enabled us to review patients at an outreach clinic on the first postoperative day. Video slit-lamp images of the patient are captured by a trained ophthalmic nurse at the outreach clinic and viewed by surgeons at Moorfields Eye Hospital in central London during live teleconsultations. During the study period, over 80 teleconsultations were carried out on postoperative cataract, trabeculectomy and combined procedures. Preliminary results are very encouraging. Although 8 (33%) of 24 patients were anxious about being involved in the teleconsultation, 20 (83%) had confidence in the system and only one (4%) found the experience unacceptable.

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Girgis, R., T. Salam e S. Verma. "To assess the results of the clinical outcome of high volume cataract operations performed by a fellow and a consultant in Moorfields Eye Hospital". Eye 26, n.º 5 (3 de fevereiro de 2012): 756–57. http://dx.doi.org/10.1038/eye.2011.357.

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Wickham, Louisa, Gordon Hay, Robin Hamilton, Jack Wooding, Harry Tossounis, Lyndon da Cruz, Dilani Siriwardena e Nick Strouthidis. "The impact of COVID policies on acute ophthalmology services—experiences from Moorfields Eye Hospital NHS Foundation Trust". Eye 34, n.º 7 (13 de maio de 2020): 1189–92. http://dx.doi.org/10.1038/s41433-020-0957-2.

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Bell, Suzannah, Urvi Karamchandani, Kirsten Malcolmson e Mariya Moosajee. "Acceptability of Telegenetics for Families with Genetic Eye Diseases". Genes 12, n.º 2 (15 de fevereiro de 2021): 276. http://dx.doi.org/10.3390/genes12020276.

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Healthcare providers around the world have implemented remote routine consultations to minimise disruption during the COVID-19 pandemic. Virtual clinics are particularly suitable for patients with genetic eye diseases as they rely on detailed histories with genetic counselling. During April–June 2019, the opinion of carers of children with inherited eye disorders attending the ocular genetics service at Moorfields Eye Hospital NHS Foundation Trust (MEH) were canvassed. Sixty-five percent of families (n = 35/54) preferred to have investigations carried out locally rather than travel to MEH, with 64% opting for a virtual consultation to interpret the results. The most popular mode of remote contact was via telephone (14/31), with video call being least preferred (8/31). Hence, 54 families who had received a telephone consultation mid-pandemic (November 2020–January 2021) were contacted to re-evaluate the acceptability of telegenetics using the Clinical Genetics Satisfaction Indicator and Telemedicine Satisfaction Questionnaire. Overall, 50 carers participated (response rate 93%); 58% of participants found teleconsultations acceptable and 54% agreed they increased their access to care, but 67.5% preferred to be seen in person. Patient satisfaction was high with 90% strongly agreeing/agreeing they shared and received all necessary information. Ocular genetics is well-suited for remote service delivery, ideally alternated with face-to-face consultations.

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Girgis, R., T. Salam e S. Verma. "Erratum: To assess the results of the clinical outcome of high volume cataract operations performed by a fellow and a consultant in Moorfields Eye Hospital". Eye 26, n.º 8 (agosto de 2012): 1156. http://dx.doi.org/10.1038/eye.2012.138.

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Leblanc, RAY. "The History of Moorfields Eye Hospital, Vol. III: Forty Years On Peter K. LeaverThe History of Moorfields Eye Hospital, Vol. III: Forty Years On Peter K. Leaver London: The Royal Society of Medicine Press Limited, 2004, 348 p., £37.50 (cloth)". Canadian Bulletin of Medical History 24, n.º 1 (abril de 2007): 235–36. http://dx.doi.org/10.3138/cbmh.24.1.235-1.

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Taylor, Paul, Craig Kennedy, Ian Murdoch, Kathy Johnston, Colin Cook e Rossi Godoumov. "Assessment of benefit in tele-ophthalmology using a consensus panel". Journal of Telemedicine and Telecare 9, n.º 3 (1 de junho de 2003): 140–45. http://dx.doi.org/10.1258/135763303767149933.

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A videoconferencing link was established from a hospital in South Africa to Moorfields Eye Hospital in London. A clinician in South Africa used a video slit-lamp and videoconferencing equipment to capture images and communicate with a specialist in London. Over 12 months, 113 cases were discussed in teleconsultations. Case-notes were subsequently obtained for 90 cases (80%). Three consultant ophthalmologists took part in the consensus process, one from the UK and two from South Africa. The consensus panel achieved on average 78–96% agreement on the items rated. In approximately half the cases, the panel judged that teleconsultation had had an effect on diagnosis. In nine cases (10%) there was potential for definite improvement in visual health as a result of tele-ophthalmology and in a further 48 cases (53%) there was potential for possible improvement in visual health. The consensus process identified 35 cases (39%) where there was potential improvement in general health as a result of tele-ophthalmology. Despite the methodological limitations of our approach, it was possible to learn a great deal about the effectiveness of the telemedicine intervention.

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Kortuem, Karsten, Katrin Fasler, Amanda Charnley, Hussain Khambati, Sandro Fasolo, Menachem Katz, Konstantinos Balaskas et al. "Implementation of medical retina virtual clinics in a tertiary eye care referral centre". British Journal of Ophthalmology 102, n.º 10 (6 de janeiro de 2018): 1391–95. http://dx.doi.org/10.1136/bjophthalmol-2017-311494.

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BackgroundThe increasing incidence of medical retinal diseases has created capacity issues across UK. In this study, we describe the implementation and outcomes of virtual medical retina clinics (VMRCs) at Moorfields Eye Hospital, South Division, London. It represents a promising solution to ensure that patients are seen and treated in a timely fashionMethodsFirst attendances in the VMRC (September 2016–May 2017) were included. It was open to non-urgent external referrals and to existing patients in a face-to-face clinic (F2FC). All patients received visual acuity testing, dilated fundus photography and optical coherence tomography scans. Grading was performed by consultants, fellows and allied healthcare professionals. Outcomes of these virtual consultations and reasons for F2FC referrals were assessed.ResultsA total number of 1729 patients were included (1543 were internal and 186 external referrals). The majority were diagnosed with diabetic retinopathy (75.1% of internal and 46.8% of external referrals). Of the internal referrals, 14.6% were discharged, 54.5% continued in VMRC and 30.9% were brought to a F2FC. Of the external referrals, 45.5% were discharged, 37.1% continued in VMRC and 17.4% were brought to a F2FC. The main reason for F2FC referrals was image quality (34.7%), followed by detection of potentially treatable disease (20.2%).ConclusionVMRC can be implemented successfully using existing resources within a hospital eye service. It may also serve as a first-line rapid-access clinic for low-risk referrals. This would enable medical retinal services to cope with increasing demand and efficiently allocate resources to those who require treatment.

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Al-Ani, Haya H., Joanne L. Sims, Oren Tomkins-Netzer, Susan Lightman e Rachael L. Niederer. "Vision loss in anterior uveitis". British Journal of Ophthalmology 104, n.º 12 (3 de abril de 2020): 1652–57. http://dx.doi.org/10.1136/bjophthalmol-2019-315551.

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AimsTo evaluate the long-term risk of permanent vision loss in subjects with anterior uveitis.MethodsRetrospective study of subjects attending uveitis clinic at Auckland District Health Board and Moorfields Eye Hospital between 2008 and 2018. Main outcome measures were: best corrected visual acuity (BCVA); moderate vision loss (MVL ≤20/50); and severe vision loss (SVL ≤20/200).Results2526 eyes of 1814 subjects were included with a mean follow-up of 6.8 years (17 235.4 eye-years of follow-up). MVL occurred in 240 eyes (9.5%) during the follow-up period, of which 97 (3.8%) had permanent MVL due to uveitis. The incidence of permanent MVL due to uveitis was 0.006 per eye-year with a cumulative risk at 10 years of 6.6% (5.2%–8.4%). The most common cause of permanent MVL due to uveitis was uveitic glaucoma (31.3%), followed by cystoid macular oedema (27.1%) and corneal scar (21.9%). SVL occurred in 80 eyes (3.2%) during the follow-up period, of which 39 (1.5%) had permanent SVL due to uveitis. The incidence of permanent SVL due to uveitis was 0.002 per eye-year with a cumulative risk at 10 years of 2.6% (1.8%–3.7%). Multivariate analysis showed older age at presentation, chronic anterior uveitis (CAU), infectious aetiology and poor presenting BCVA were all risk factors for permanent MVL due to uveitis.ConclusionsAlthough vision loss is an uncommon complication in anterior uveitis, the risk is greatest in those with CAU, infectious aetiology and poor presenting BCVA. Uveitic glaucoma is the most common cause of vision loss.

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Eweiss, A. Z., V. J. Lund, A. Jay e G. Rose. "Transitional cell tumours of the lacrimal drainage apparatus". Rhinology journal 51, n.º 4 (1 de dezembro de 2013): 349–54. http://dx.doi.org/10.4193/rhino13.016.

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Background: Tumours of the lacrimal drainage apparatus (LDA) are very rare, but can be life-threatening. Seventy percent of lacrimal sac tumours are of epithelial origin, and transitional cell tumours represent an interesting sub-group of these epithelial tumours. Methods: A retrospective review of cases of LDA transitional cell tumours co-managed at the Royal National Throat Nose and Ear Hospital and Moorfields Eye Hospital, London. Results: Twenty cases of transitional cell tumours of the LDA were identified, comprising 10 transitional cell papillomas (TCPs) and 10 transitional cell carcinomas (TCCs). All cases were resected through a modified lateral rhinotomy approach. Limited resection of orbital fat with preservation of orbital functions was required for 2 cases of TCC. Fractionated external beam radiotherapy was administered in 7 cases of TCC. The mean follow up was 80 months (range 11 months-16 years). Recurrences were detected in 4 cases, which were managed by further surgery. Two cases have been lost to follow-up, but the 18 other patients are currently alive and disease free. Conclusion: A favourable outcome can be achieved with transitional cell tumours of the LDA when an optimum management plan is followed.

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Kern, Christoph, Dun Jack Fu, Karsten Kortuem, Josef Huemer, David Barker, Alison Davis, Konstantinos Balaskas, Pearse A. Keane, Tom McKinnon e Dawn A. Sim. "Implementation of a cloud-based referral platform in ophthalmology: making telemedicine services a reality in eye care". British Journal of Ophthalmology 104, n.º 3 (18 de julho de 2019): 312–17. http://dx.doi.org/10.1136/bjophthalmol-2019-314161.

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BackgroundHospital Eye Services (HES) in the UK face an increasing number of optometric referrals driven by progress in retinal imaging. The National Health Service (NHS) published a 10-year strategy (NHS Long-Term Plan) to transform services to meet this challenge. In this study, we implemented a cloud-based referral platform to improve communication between optometrists and ophthalmologists.MethodsRetrospective cohort study conducted at Moorfields Eye Hospital, Croydon (NHS Foundation Trust, London, UK). Patients classified into the HES referral pathway by contributing optometrists have been included into this study. Main outcome measures was the reduction of unnecessary referrals.ResultsAfter reviewing the patient’s data in a web-based interface 54 (52%) out of 103 attending patients initially classified into the referral pathway did not need a specialist referral. Fourteen (14%) patients needing urgent treatment were identified. Usability was measured in duration for data input and reviewing which was an average of 9.2 min (median: 5.4; IQR: 3.4–8.7) for optometrists and 3.0 min (median: 3.0; IQR: 1.7–3.9) min for ophthalmologists. A variety of diagnosis was covered by this tool with dry age-related macular degeneration (n=34) being most common.ConclusionAfter implementation more than half of the HES referrals have been avoided. This platform offers a digital-first solution that enables rapid-access eye care for patients in community optometrists, facilitates communication between healthcare providers and may serve as a foundation for implementation of artificial intelligence.

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Gilbert, Rose M., Dayyanah Sumodhee, Nikolas Pontikos, Catherine Hollyhead, Angus Patrick, Samuel Scarles, Sabrina Van Der Smissen et al. "Collaborative Research and Development of a Novel, Patient-Centered Digital Platform (MyEyeSite) for Rare Inherited Retinal Disease Data: Acceptability and Feasibility Study". JMIR Formative Research 6, n.º 1 (31 de janeiro de 2022): e21341. http://dx.doi.org/10.2196/21341.

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Background Inherited retinal diseases (IRDs) are a leading cause of blindness in children and working age adults in the United Kingdom and other countries, with an appreciable socioeconomic impact. However, by definition, IRD data are individually rare, and as a result, this patient group has been underserved by research. Researchers need larger amounts of these rare data to make progress in this field, for example, through the development of gene therapies. The challenge has been how to find and make these data available to researchers in the most productive way. MyEyeSite is a research collaboration aiming to design and develop a digital platform (the MyEyeSite platform) for people with rare IRDs that will enable patients, doctors, and researchers to aggregate and share specialist eye health data. A crucial component of this platform is the MyEyeSite patient application, which will provide the means for patients with IRD to interact with the system and, in particular, to collate, manage, and share their personal specialist IRD data both for research and their own health care. Objective This study aims to test the acceptability and feasibility of the MyEyeSite platform in the target IRD population through a collaborative patient-centered study. Methods Qualitative data were generated through focus groups and workshops, and quantitative data were obtained through a survey of patients with IRD. Participants were recruited through clinics at Moorfields Eye Hospital National Health Service (NHS) Foundation Trust and the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre through their patient and public involvement databases. Results Our IRD focus group sample (n=50) highlighted the following themes: frustration with the current system regarding data sharing within the United Kingdom’s NHS; positive expectations of the potential benefits of the MyEyeSite patient application, resulting from increased access to this specialized data; and concerns regarding data security, including potentially unethical use of the data outside the NHS. Of the surveyed 80 participants, 68 (85%) were motivated to have a more active role in their eye care and share their data for research purposes using a secure technology, such as a web application or mobile app. Conclusions This study demonstrates that patients with IRD are highly motivated to be actively involved in managing their own data for research and their own eye care. It demonstrates the feasibility of involving patients with IRD in the detailed design of the MyEyeSite platform exemplar, with input from the patient with IRD workshops playing a key role in determining both the functionality and accessibility of the designs and prototypes. The development of a user-centered technological solution to the problem of rare health data has the potential to benefit not only the patient with IRD community but also others with rare diseases.

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Faes, Livia, Amit V. Mishra, Veronika Lipkova, Konstantinos Balaskas, Chrystie Quek, Robin Hamilton, Ulrike Held, Dawn Sim, Sobha Sivaprasad e Dun Jack Fu. "Visual and Anatomical Outcomes of a Single Intravitreal Dexamethasone in Diabetic Macular Edema: An 8 Year Real-World Study". Journal of Clinical Medicine 12, n.º 12 (6 de junho de 2023): 3878. http://dx.doi.org/10.3390/jcm12123878.

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Importance: Diabetic macular edema (DME) is a major cause of vision loss in patients with diabetes mellitus. Intravitreal dexamethasone is a treatment option for patients unsuitable for or non-responsive to anti-angiogenic agents. Objective: To quantify visual and anatomical outcomes from an initial intravitreal dexamethasone injection over the expected 6-month period of dexamethasone release by the implant. Design and enrolment: This is a retrospective cohort study using electronic medical records of patients reviewed between 1 January 2012 and 1 April 2022. Setting: A tertiary eye-care center in London, United Kingdom; Moorfields Eye Hospital National Healthcare System Foundation Trust. Participants: The cohort comprised 418 adult patients with DME who received an initial treatment of 700 µg intravitreal dexamethasone in the study period. Of these, 240 patients met the inclusion criteria of ≥2 hospital visits following initial injection (≥1 beyond 6 months) and no previous ocular corticosteroid treatment or missing assessment at baseline. Exposure(s): Intravitreal dexamethasone implant (700 µg). Main Outcome(s) and Measure(s): Probability of a positive visual outcome, defined as ≥5 or ≥10 Early Treatment Diabetic Retinopathy Study (ETDRS)-letter gain after treatment when compared to baseline (Kaplan–Meier models). Results: From the initial intravitreal dexamethasone injection alone, we observed a >75% chance of gaining ≥5 ETDRS letters and >50% chance of gaining ≥10 ETDRS letters within 6 months. There was less than a 50% chance of sustaining either positive visual outcome beyond 4 months. Conclusions and Relevance: Most patients can be expected to have a positive visual outcome following an initial injection of dexamethasone implants that subsides within 4 months. Real-world re-treatment was observed to be delayed until after visual benefits were lost in half of the cohort. Further research will be needed to study the effects of delays in re-treatment.

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Islam, Farrah, Mark Westcott, Angela Rees, Anthony George Robson, Bharat Kapoor, Graham Holder e Carlos Pavesio. "Safety profile and efficacy of tacrolimus in the treatment of birdshot retinochoroiditis: a retrospective case series review". British Journal of Ophthalmology 102, n.º 7 (19 de outubro de 2017): 983–90. http://dx.doi.org/10.1136/bjophthalmol-2017-310436.

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AimEvaluation of the use of tacrolimus in the treatment of birdshot retinochoroiditis (BRC) at a tertiary referral centre with the aim to describe its safety and efficacy.MethodsThe medical records of 25 patients diagnosed with BRC at uveitis service, Moorfields Eye Hospital, and who had received tacrolimus treatment were retrospectively reviewed. The main outcome measures of the study were (1) safety of tacrolimus in terms of side effects and (2) efficacy, as measured both by control of inflammation and visual function assessed by Humphrey visual fields and electrophysiological testing over at least 6 months and then 1 year.ResultsTacrolimus was commenced in 25 patients (mean age 50.4±10.8 years) and was well tolerated in 21 patients (84%). It was necessary to stop the tacrolimus in four patients. No patient showed major changes in renal function: 3/21 patients (14.28%) showed slightly abnormal (less than 30%) function at the end of the first month of treatment; 1/21 (4.76%) patients at 3 months, but at the end of a 6-month treatment period only 1/21 patients (4.76%) showed minor abnormality in renal function. The mean daily prednisolone dose was 19.7 mg at the beginning of the study, which had fallen to 6.9 mg at the end (t=5.071, p=0.001). Visual acuity mostly remained stable. Visual fields improved over time (mean improvement in Humphrey mean deviation, right eye=1.8±2.4 dB, t=3.821, p=0.004; left eye=1.9±2.7, dB, t=3.06, p=0.007). Electrophysiological function showed improvement in 10 patients, and in four patients an initial deterioration in function improved following tacrolimus dose adjustment.ConclusionTacrolimus has a good safety profile for long-term use in patients with BRC as a second-line agent enabling steroid sparing and visual function stabilisation or improvement.

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De Fauw, Jeffrey, Pearse Keane, Nenad Tomasev, Daniel Visentin, George van den Driessche, Mike Johnson, Cian O. Hughes et al. "Automated analysis of retinal imaging using machine learning techniques for computer vision". F1000Research 5 (5 de julho de 2016): 1573. http://dx.doi.org/10.12688/f1000research.8996.1.

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There are almost two million people in the United Kingdom living with sight loss, including around 360,000 people who are registered as blind or partially sighted. Sight threatening diseases, such as diabetic retinopathy and age related macular degeneration have contributed to the 40% increase in outpatient attendances in the last decade but are amenable to early detection and monitoring. With early and appropriate intervention, blindness may be prevented in many cases. Ophthalmic imaging provides a way to diagnose and objectively assess the progression of a number of pathologies including neovascular (“wet”) age-related macular degeneration (wet AMD) and diabetic retinopathy. Two methods of imaging are commonly used: digital photographs of the fundus (the ‘back’ of the eye) and Optical Coherence Tomography (OCT, a modality that uses light waves in a similar way to how ultrasound uses sound waves). Changes in population demographics and expectations and the changing pattern of chronic diseases creates a rising demand for such imaging. Meanwhile, interrogation of such images is time consuming, costly, and prone to human error. The application of novel analysis methods may provide a solution to these challenges. This research will focus on applying novel machine learning algorithms to automatic analysis of both digital fundus photographs and OCT in Moorfields Eye Hospital NHS Foundation Trust patients. Through analysis of the images used in ophthalmology, along with relevant clinical and demographic information, Google DeepMind Health will investigate the feasibility of automated grading of digital fundus photographs and OCT and provide novel quantitative measures for specific disease features and for monitoring the therapeutic success.

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De Fauw, Jeffrey, Pearse Keane, Nenad Tomasev, Daniel Visentin, George van den Driessche, Mike Johnson, Cian O. Hughes et al. "Automated analysis of retinal imaging using machine learning techniques for computer vision". F1000Research 5 (22 de junho de 2017): 1573. http://dx.doi.org/10.12688/f1000research.8996.2.

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There are almost two million people in the United Kingdom living with sight loss, including around 360,000 people who are registered as blind or partially sighted. Sight threatening diseases, such as diabetic retinopathy and age related macular degeneration have contributed to the 40% increase in outpatient attendances in the last decade but are amenable to early detection and monitoring. With early and appropriate intervention, blindness may be prevented in many cases. Ophthalmic imaging provides a way to diagnose and objectively assess the progression of a number of pathologies including neovascular (“wet”) age-related macular degeneration (wet AMD) and diabetic retinopathy. Two methods of imaging are commonly used: digital photographs of the fundus (the ‘back’ of the eye) and Optical Coherence Tomography (OCT, a modality that uses light waves in a similar way to how ultrasound uses sound waves). Changes in population demographics and expectations and the changing pattern of chronic diseases creates a rising demand for such imaging. Meanwhile, interrogation of such images is time consuming, costly, and prone to human error. The application of novel analysis methods may provide a solution to these challenges. This research will focus on applying novel machine learning algorithms to automatic analysis of both digital fundus photographs and OCT in Moorfields Eye Hospital NHS Foundation Trust patients. Through analysis of the images used in ophthalmology, along with relevant clinical and demographic information, DeepMind Health will investigate the feasibility of automated grading of digital fundus photographs and OCT and provide novel quantitative measures for specific disease features and for monitoring the therapeutic success.

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Tsai, Wei-Shan, Sridevi Thottarath, Sarega Gurudas, Piyali Sen, Elizabeth Pearce, Andrea Giani, Victor Chong, Chui Ming Gemmy Cheung e Sobha Sivaprasad. "Correlation of Optical Coherence Tomography Angiography Characteristics with Visual Function to Define Vision-Threatening Diabetic Macular Ischemia". Diagnostics 12, n.º 5 (22 de abril de 2022): 1050. http://dx.doi.org/10.3390/diagnostics12051050.

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The thresholds of macular microvasculature parameters associated with mild visual impairment in diabetic macular ischemia (DMI) patients are unclear. Therefore, this prospective observational study is aimed at demonstrating the optical coherence tomography angiography parameters that best correlate with mild visual impairment (< 70 Early Treatment Diabetic Retinopathy Study (ETDRS) letters, Snellen equivalent 20/40) in DMI. The study was completed at the Moorfields Eye Hospital from December 2019 to August 2021. A total of 123 eyes of 87 patients with stable-treated proliferative diabetic retinopathy following panretinal photocoagulation were recruited. DMI was defined as an irregular foveal avascular zone (FAZ) area ≥ 0.5 mm2 or a smaller FAZ area with parafoveal capillary dropout in at least one quadrant. The analysis showed that the whole image deep vascular complex vessel density (DVC VD) in the 3 × 3 mm area had the best discriminatory ability to identify participants with mild visual impairment at 41.9% (area under the curve = 0.77, sensitivity 94%, specificity 54%, likelihood ratio [LR] = 2.04), and the FAZ area had the greatest post-test LR = 4.21 at 0.64 mm2. The 3 × 3 mm whole image DVC VD and FAZ area cutoffs are useful for screening vision-threatening DMI, but DVC VD has low specificity.

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Garway-Heath, David F., Haogang Zhu, Qian Cheng, Katy Morgan, Chris Frost, David P. Crabb, Tuan-Anh Ho e Yannis Agiomyrgiannakis. "Combining optical coherence tomography with visual field data to rapidly detect disease progression in glaucoma: a diagnostic accuracy study". Health Technology Assessment 22, n.º 4 (janeiro de 2018): 1–106. http://dx.doi.org/10.3310/hta22040.

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Background Progressive optic nerve damage in glaucoma results in vision loss, quantifiable with visual field (VF) testing. VF measurements are, however, highly variable, making identification of worsening vision (‘progression’) challenging. Glaucomatous optic nerve damage can also be measured with imaging techniques such as optical coherence tomography (OCT). Objective To compare statistical methods that combine VF and OCT data with VF-only methods to establish whether or not these allow (1) more rapid identification of glaucoma progression and (2) shorter or smaller clinical trials. Design Method ‘hit rate’ (related to sensitivity) was evaluated in subsets of the United Kingdom Glaucoma Treatment Study (UKGTS) and specificity was evaluated in 72 stable glaucoma patients who had 11 VF and OCT tests within 3 months (the RAPID data set). The reference progression detection method was based on Guided Progression Analysis™ (GPA) Software (Carl Zeiss Meditec Inc., Dublin, CA, USA). Index methods were based on previously described approaches [Analysis with Non-Stationary Weibull Error Regression and Spatial enhancement (ANSWERS), Permutation analyses Of Pointwise Linear Regression (PoPLR) and structure-guided ANSWERS (sANSWERS)] or newly developed methods based on Permutation Test (PERM), multivariate hierarchical models with multiple imputation for censored values (MaHMIC) and multivariate generalised estimating equations with multiple imputation for censored values (MaGIC). Setting Ten university and general ophthalmology units (UKGTS) and a single university ophthalmology unit (RAPID). Participants UKGTS participants were newly diagnosed glaucoma patients randomised to intraocular pressure-lowering drops or placebo. RAPID participants had glaucomatous VF loss, were on treatment and were clinically stable. Interventions 24-2 VF tests with the Humphrey Field Analyzer and optic nerve imaging with time-domain (TD) Stratus OCT™ (Carl Zeiss Meditec Inc., Dublin, CA, USA). Main outcome measures Criterion hit rate and specificity, time to progression, future VF prediction error, proportion progressing in UKGTS treatment groups, hazard ratios (HRs) and study sample size. Results Criterion specificity was 95% for all tests; the hit rate was 22.2% for GPA, 41.6% for PoPLR, 53.8% for ANSWERS and 61.3% for sANSWERS (all comparisons p ≤ 0.042). Mean survival time (weeks) was 93.6 for GPA, 82.5 for PoPLR, 72.0 for ANSWERS and 69.1 for sANSWERS. The median prediction errors (decibels) when the initial trend was used to predict the final VF were 3.8 (5th to 95th percentile 1.7 to 7.6) for PoPLR, 3.0 (5th to 95th percentile 1.5 to 5.7) for ANSWERS and 2.3 (5th to 95th percentile 1.3 to 4.5) for sANSWERS. HRs were 0.57 [95% confidence interval (CI) 0.34 to 0.90; p = 0.016] for GPA, 0.59 (95% CI 0.42 to 0.83; p = 0.002) for PoPLR, 0.76 (95% CI 0.56 to 1.02; p = 0.065) for ANSWERS and 0.70 (95% CI 0.53 to 0.93; p = 0.012) for sANSWERS. Sample size estimates were not reduced using methods including OCT data. PERM hit rates were between 8.3% and 17.4%. Treatment effects were non-significant in MaHMIC and MaGIC analyses; statistical significance was altered little by incorporating imaging. Limitations TD OCT is less precise than current imaging technology; current OCT technology would likely perform better. The size of the RAPID data set limited the precision of criterion specificity estimates. Conclusions The sANSWERS method combining VF and OCT data had a higher hit rate and identified progression more quickly than the reference and other VF-only methods, and produced more accurate estimates of the progression rate, but did not increase treatment effect statistical significance. Similar studies with current OCT technology need to be undertaken and the statistical methods need refinement. Trial registration Current Controlled Trials ISRCTN96423140. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 4. See the NIHR Journals Library website for further project information. Data analysed in the study were from the UKGTS. Funding for the UKGTS was provided through an unrestricted investigator-initiated research grant from Pfizer Inc. (New York, NY, USA), with supplementary funding from the NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK. Imaging equipment loans were made by Heidelberg Engineering, Carl Zeiss Meditec and Optovue (Fremont, CA, USA). Pfizer, Heidelberg Engineering, Carl Zeiss Meditec and Optovue had no input into the design, conduct, analysis or reporting of any of the UKGTS findings or this work. The sponsor for both the UKGTS and RAPID data collection was Moorfields Eye Hospital NHS Foundation Trust. David F Garway-Heath, Tuan-Anh Ho and Haogang Zhu are partly funded by the NIHR Biomedical Research Centre based at Moorfields Eye Hospital and UCL Institute of Ophthalmology. David F Garway-Heath’s chair at University College London (UCL) is supported by funding from the International Glaucoma Association.

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Larkin, Daniel FP, Kashfia Chowdhury, Caroline J. Doré, Catey Bunce, Jennifer M. Burr, Emilia Caverly, Lisa French et al. "Epithelium-off corneal cross-linking surgery compared with standard care in 10- to 16-year-olds with progressive keratoconus: the KERALINK RCT". Efficacy and Mechanism Evaluation 8, n.º 15 (outubro de 2021): 1–46. http://dx.doi.org/10.3310/eme08150.

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Background Keratoconus is a disease of the cornea affecting vision that is usually first diagnosed in the first three decades. The abnormality of corneal shape and thickness tends to progress until the patient reaches approximately 30 years of age. Epithelium-off corneal cross-linking is a procedure that has been demonstrated to be effective in randomised trials in adults and observational studies in young patients. Objectives The KERALINK trial examined the efficacy and safety of epithelium-off corneal cross-linking, compared with standard care by spectacle or contact lens correction, for stabilisation of progressive keratoconus. Design In this observer-masked, randomised, controlled, parallel-group superiority trial, 60 participants aged 10–16 years with progressive keratoconus were randomised; 58 participants completed the study. Progression was defined as a 1.5 D increase in corneal power measured by maximum or mean power (K2) in the steepest corneal meridian in the study eye, measured by corneal tomography. Setting Referral clinics in four UK hospitals. Interventions Participants were randomised to corneal cross-linking plus standard care or standard care alone, with spectacle or contact lens correction as necessary for vision, and were monitored for 18 months. Main outcome measures The primary outcome was K2 in the study eye as a measure of the steepness of the cornea at 18 months post randomisation. Secondary outcomes included keratoconus progression, visual acuity, keratoconus apex corneal thickness and quality of life. Results Of 60 participants, 30 were randomised to the corneal cross-linking and standard-care groups. Of these, 30 patients in the corneal cross-linking group and 28 patients in the standard-care group were analysed. The mean (standard deviation) K2 in the study eye at 18 months post randomisation was 49.7 D (3.8 D) in the corneal cross-linking group and 53.4 D (5.8 D) in the standard-care group. The adjusted mean difference in K2 in the study eye was –3.0 D (95% confidence interval –4.93 D to –1.08 D; p = 0.002), favouring corneal cross-linking. Uncorrected and corrected differences in logMAR vision at 18 months were better in eyes receiving corneal cross-linking: –0.31 (95% confidence interval –0.50 to –0.11; p = 0.002) and –0.30 (95% confidence interval –0.48 to –0.11; p = 0.002). Keratoconus progression in the study eye occurred in two patients (7%) randomised to corneal cross-linking compared with 12 (43%) patients randomised to standard care. The unadjusted odds ratio suggests that, on average, patients in the corneal cross-linking group had 90% (odds ratio 0.1, 95% confidence interval 0.02 to 0.48; p = 0.004) lower odds of experiencing progression than those receiving standard care. Quality-of-life outcomes were similar in both groups. No adverse events were attributable to corneal cross-linking. Limitations Measurements of K2 in those eyes with the most significant progression were in some cases indicated as suspect by corneal topography device software. Conclusions Corneal cross-linking arrests progression of keratoconus in the great majority of young patients. These data support a consideration of a change in practice, such that corneal cross-linking could be considered as first-line treatment in progressive disease. If the arrest of keratoconus progression induced by corneal cross-linking is sustained in longer follow-up, there may be particular benefit in avoiding the later requirement for contact lens wear or corneal transplantation. However, keratoconus does not continue to progress in all patients receiving standard care. For future work, the most important questions to be answered are whether or not (1) the arrest of keratoconus progression induced by corneal cross-linking is maintained in the long term and (2) the proportion of those receiving standard care who show significant progression increases with time. Trial registration Current Controlled Trials ISRCTN17303768 and EudraCT 2016-001460-11. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 15. See the NIHR Journals Library website for further project information. The trial sponsor is University College London. This research was otherwise supported in part by the NIHR Moorfields Biomedical Research Centre and the NIHR Moorfields Clinical Research Facility, London, United Kingdom.

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Han, Ji Eun Diana, Xiaoxuan Liu, Catey Bunce, Abdel Douiri, Luke Vale, Ann Blandford, John Lawrenson et al. "Teleophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease (HERMES): a Cluster Randomised Superiority Trial with a linked Diagnostic Accuracy Study—HERMES study report 1—study protocol". BMJ Open 12, n.º 2 (fevereiro de 2022): e055845. http://dx.doi.org/10.1136/bmjopen-2021-055845.

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IntroductionRecent years have witnessed an upsurge of demand in eye care services in the UK. With a large proportion of patients referred to Hospital Eye Services (HES) for diagnostics and disease management, the referral process results in unnecessary referrals from erroneous diagnoses and delays in access to appropriate treatment. A potential solution is a teleophthalmology digital referral pathway linking community optometry and HES.Methods and analysisThe HERMES study (Teleophthalmology-enabled and artificial intelligence-ready referral pathway for community optometry referrals of retinal disease: a cluster randomised superiority trial with a linked diagnostic accuracy study) is a cluster randomised clinical trial for evaluating the effectiveness of a teleophthalmology referral pathway between community optometry and HES for retinal diseases. Nested within HERMES is a diagnostic accuracy study, which assesses the accuracy of an artificial intelligence (AI) decision support system (DSS) for automated diagnosis and referral recommendation. A postimplementation, observational substudy, a within-trial economic evaluation and discrete choice experiment will assess the feasibility of implementation of both digital technologies within a real-life setting. Patients with a suspicion of retinal disease, undergoing eye examination and optical coherence tomography (OCT) scans, will be recruited across 24 optometry practices in the UK. Optometry practices will be randomised to standard care or teleophthalmology. The primary outcome is the proportion of false-positive referrals (unnecessary HES visits) in the current referral pathway compared with the teleophthalmology referral pathway. OCT scans will be interpreted by the AI DSS, which provides a diagnosis and referral decision and the primary outcome for the AI diagnostic study is diagnostic accuracy of the referral decision made by the Moorfields-DeepMind AI system. Secondary outcomes relate to inappropriate referral rate, cost-effectiveness analyses and human–computer interaction (HCI) analyses.Ethics and disseminationEthical approval was obtained from the London—Bromley Research Ethics Committee (REC 20/LO/1299). Findings will be reported through academic journals in ophthalmology, health services research and HCI.Trial registration numberISRCTN18106677 (protocol V.1.1).

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Chan, Hwei Wuen, Elena R. Schiff, Vijay K. Tailor, Samantha Malka, Magella M. Neveu, Maria Theodorou e Mariya Moosajee. "Prospective Study of the Phenotypic and Mutational Spectrum of Ocular Albinism and Oculocutaneous Albinism". Genes 12, n.º 4 (30 de março de 2021): 508. http://dx.doi.org/10.3390/genes12040508.

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Albinism encompasses a group of hereditary disorders characterized by reduced or absent ocular pigment and variable skin and/or hair involvement, with syndromic forms such as Hermansky–Pudlak syndrome and Chédiak–Higashi syndrome. Autosomal recessive oculocutaneous albinism (OCA) is phenotypically and genetically heterogenous (associated with seven genes). X-linked ocular albinism (OA) is associated with only one gene, GPR143. We report the clinical and genetic outcomes of 44 patients, from 40 unrelated families of diverse ethnicities, with query albinism presenting to the ocular genetics service at Moorfields Eye Hospital NHS Foundation Trust between November 2017 and October 2019. Thirty-six were children (≤ 16 years) with a median age of 31 months (range 2–186), and eight adults with a median age of 33 years (range 17–39); 52.3% (n = 23) were male. Genetic testing using whole genome sequencing (WGS, n = 9) or a targeted gene panel (n = 31) gave an overall diagnostic rate of 42.5% (44.4% (4/9) with WGS and 41.9% (13/31) with panel testing). Seventeen families had confirmed mutations in TYR (n = 9), OCA2, (n = 4), HPS1 (n = 1), HPS3 (n = 1), HPS6 (n = 1), and GPR143 (n = 1). Molecular diagnosis of albinism remains challenging due to factors such as missing heritability. Differential diagnoses must include SLC38A8-associated foveal hypoplasia and syndromic forms of albinism.

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Rodriguez-Martinez, Ana Catalina, Bethany Elora Higgins, Vijay Tailor-Hamblin, Samantha Malka, Riccardo Cheloni, Alexander Mark Collins, John Bladen, Robert Henderson e Mariya Moosajee. "Foveal Hypoplasia in CRB1-Related Retinopathies". International Journal of Molecular Sciences 24, n.º 18 (11 de setembro de 2023): 13932. http://dx.doi.org/10.3390/ijms241813932.

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The CRB1 gene plays a role in retinal development and its maintenance. When disrupted, it gives a range of phenotypes such as early-onset severe retinal dystrophy/Leber congenital amaurosis (EOSRD/LCA), retinitis pigmentosa (RP), cone-rod dystrophy (CORD) and macular dystrophy (MD). Studies in CRB1 retinopathies have shown thickening and coarse lamination of retinal layers resembling an immature retina. Its role in foveal development has not yet been described; however, this retrospective study is the first to report foveal hypoplasia (FH) presence in a CRB1-related retinopathy cohort. Patients with pathogenic biallelic CRB1 variants from Moorfields Eye Hospital, London, UK, were collected. Demographic, clinical data and SD-OCT analyses with FH structural grading were performed. A total of 15 (48%) patients had EOSRD/LCA, 11 (35%) MD, 3 (9%) CORD and 2 (6%) RP. FH was observed in 20 (65%; CI: 0.47–0.79) patients, all of whom were grade 1. A significant difference in BCVA between patients with FH and without was found (p = 0.014). BCVA continued to worsen over time in both groups (p < 0.001), irrespective of FH. This study reports FH in a CRB1 cohort, supporting the role of CRB1 in foveal development. FH was associated with poorer BCVA and abnormal retinal morphology. Nonetheless, its presence did not alter the disease progression.

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Gilhooley, Michael James, Naz Raoof, Patrick Yu-Wai-Man e Mariya Moosajee. "Inherited Optic Neuropathies: Real-World Experience in the Paediatric Neuro-Ophthalmology Clinic". Genes 15, n.º 2 (30 de janeiro de 2024): 188. http://dx.doi.org/10.3390/genes15020188.

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Inherited optic neuropathies affect around 1 in 10,000 people in England; in these conditions, vision is lost as retinal ganglion cells lose function or die (usually due to pathological variants in genes concerned with mitochondrial function). Emerging gene therapies for these conditions have emphasised the importance of early and expedient molecular diagnoses, particularly in the paediatric population. Here, we report our real-world clinical experience of such a population, exploring which children presented with the condition, how they were investigated and the time taken for a molecular diagnosis to be reached. A retrospective case-note review of paediatric inherited optic neuropathy patients (0–16 years) in the tertiary neuro-ophthalmology service at Moorfields Eye Hospital between 2016 and 2020 identified 19 patients. Their mean age was 9.3 ± 4.6 (mean ± SD) years at presentation; 68% were male, and 32% were female; and 26% had comorbidities, with diversity of ethnicity. Most patients had undergone genetic testing (95% (n = 18)), of whom 43% (n = 8) received a molecular diagnosis. On average, this took 54.8 ± 19.5 weeks from presentation. A cerebral MRI was performed in 70% (n = 14) and blood testing in 75% (n = 15) of patients as part of their workup. Continual improvement in the investigative pathways for inherited optic neuropathies will be paramount as novel therapeutics become available.

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Whitfield, Adrian, e Giles Colin. "Infected cornea graft - no negligence or breach of statutory duty: Ndri v Moorfields Eye Hospital NHS Trust (High Court, 24/11/06 - Sir Douglas Brown)". Clinical Risk 13, n.º 4 (1 de julho de 2007): 167–68. http://dx.doi.org/10.1258/135626207781251040.

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49

Bell, Suzannah, Samantha Malka, Ian Christopher Lloyd e Mariya Moosajee. "Clinical Spectrum and Genetic Diagnosis of 54 Consecutive Patients Aged 0–25 with Bilateral Cataracts". Genes 12, n.º 2 (21 de janeiro de 2021): 131. http://dx.doi.org/10.3390/genes12020131.

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Childhood cataract affects 2.5–3.5 per 10,000 children in the UK, with a genetic mutation identified in 50–90% of bilateral cases. However, cataracts can also manifest in adolescence and early adulthood in isolation, as part of a complex ocular phenotype or with systemic features making accurate diagnosis more challenging. We investigate our real-world experience through a retrospective review of consecutive bilateral cataract patients (0–25 years) presenting to the ocular genetics service at Moorfields Eye Hospital between 2017 and 2020. Fifty-four patients from 44 unrelated families were identified, with a median age of 13.5 years (range 1 to 68 years) and a median age at diagnosis of 43.9 months IQR (1.7–140.3 months); 40.7% were female and 46.3% were Caucasian. Overall, 37 patients from 27 families (61.4%) were genetically solved (50%) or likely solved (additional 11.4%), with 26 disease-causing variants (8 were novel) in 21 genes; the most common were crystallin genes, in 8 (29.6%) families, with half occurring in the CRYBB2 gene. There was no significant difference in the molecular diagnostic rates between sporadic and familial inheritance (P = 0.287). Associated clinical diagnoses were retinal dystrophies in five (18.5%) and aniridia in three (11.1%) families. Bilateral cataracts were the presenting feature in 27.3% (6/22) of either complex or syndromic cases, and isolated cataract patients were 11.5 years younger (rank-sum Z = 3.668, P = 0.0002). Prompt genetic investigation with comprehensive panel testing can aid with diagnosis and optimise management of cataract patients.

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50

Cheloni, Riccardo, Daniel Jackson e Mariya Moosajee. "A Natural History Study of RP2-Related Retinopathy". Journal of Clinical Medicine 11, n.º 23 (22 de novembro de 2022): 6877. http://dx.doi.org/10.3390/jcm11236877.

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X-linked retinitis pigmentosa (RP) is a severe form of RP, often with early macular involvement. This study aimed to characterise the natural history of patients with a diagnosis of X-linked RP due to RP2 mutations. Clinical details, best-corrected visual acuity (BCVA) and multimodal retinal imaging were retrospectively collected from patients with RP2 variants from Moorfields Eye Hospital (London, UK). Measures of the ellipsoid-zone (EZ) width, central retinal thickness (CRT), and thickness of the photoreceptor and retinal pigment epithelium complex (PR+RPE, taken between the external limiting membrane and RPE) were extracted from spectral-domain optical coherence tomography (SD-OCT) scans. A total of 47 affected males (median baseline age: 20 years, IQR: 12.5–36.5) were included, and 41 had two or more visits (median follow-up: 8.0 years, IQR: 3.2–14.5). A total of 24 RP2 variants were identified, 13 of which were novel. BCVA dropped from 0.66 LogMAR at baseline (IQR, 0.35–1.4) to 1.3 LogMAR at the most recent visit (IQR: 0.6–1.4). SD-OCT revealed a prevalent outer retinal atrophy (n = 23/35, 65.7%), and measurable EZ width at baseline in 34.3% of patients (n = 12). Age significantly affected all quantitative measures (p < 0.001) except EZ width (p = 0.58), with exponential decays of 46–49% and 12.6–33.9% per decade for BCVA and SD-OCT measures, respectively. RP2 patients exhibited rapid progression to outer retina atrophy and early macular involvement with substantial vision loss by age 30–40.

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