Choroida https://choroida.com Ophthalmic Market for Ophthalmology Tools and Devices Mon, 30 May 2022 12:38:08 +0000 en-US hourly 1 https://wordpress.org/?v=6.0 https://choroida.com/wp-content/uploads/2022/01/cropped-choroida__1_-removebg-preview-32x32.png Choroida https://choroida.com 32 32 A retina checkup to the cat, boji by smartphone !! https://choroida.com/a-retina-checkup-to-the-cat-boji-by-smartphone.html Thu, 26 May 2022 20:48:53 +0000 https://choroida.com/?p=11025 Animals suffer from eye problems that are similar to those which affect humans. These problems include cataracts, glaucoma, dry eye, corneal ulceration, tumors of the eye, eyelid defects, inflammation of the eye and surrounding tissues, retinal degeneration, and many others. Owners may notice a loss of vision, a change in appearance of the eye, discharge, [...]

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Animals suffer from eye problems that are similar to those which affect humans. These problems include cataracts, glaucoma, dry eye, corneal ulceration, tumors of the eye, eyelid defects, inflammation of the eye and surrounding tissues, retinal degeneration, and many others. Owners may notice a loss of vision, a change in appearance of the eye, discharge, pain, or a combination of these symptoms. Most cases seen by a veterinary ophthalmologist are referred by a general practice veterinarian. This individual is in the best position to provide an initial examination and determine if a referral to a specialist is indicated.

Vision in general is complex and involves many environmental and anatomic factors.

Cat’s eyes function quite similarly to our human eyes but they have differences due to their anatomy that make their vision slightly different in some aspects.

The previous concept is the cornerstone for building a smartphone fundoscope for animals like dogs, cats and horses.

What’s smartphone fundoscope?

A device which turns any smartphone into fundus camera.. a whole retina checkup for the animal can be fulfilled by only smartphone.

Animal’s vision always depend on many factors like, condition of cornea, lens and retina..

cornea and lens lesions are always checked by portable slit-lamp while the retina is mostly missed due to difficulty of its examination. also the lack of indirect ophthalmoscope and that hustle of bringing in the animal and set it for examination.

Retina Checkup is now possible than ever. easier than ever..

the smartphone fundoscope offer the portability, the low cost and the best practice for ophthalmology vets.

let’s explain more;

Portability

The device requires only attaching the smartphone to it, less than 100gm weight, 20cm long & no wires at all.

Lowest Cost

That concept of turning smartphone into fundus camera has been developed to replace indirect ophthalmoscope hustle and save 70% of budget!

the device uses smartphone gear and turn it to a 4k camera that visualize the retina on smartphone screen. record the whole exam in video mode.

Best Practice

Capturing images of retina and record the whole exam of retina,, the device adds a great value to the exam. allowing the Vet. to explain the condition more perfectly to the animal owner.

offer the best way for follow up a retina : capture it.. wait for the treatment to do its magic.. capture it again.. compare both retina images.

How smartphone fundoscope works ?!

The device consists of a light source, 22D lens and attachment ring for the smartphone..
Once the phone is attached, the light source will be turned on automatically.
smartphone fundoscope

lets see how it work on human eye “typical as animal eyes”

You need to dilate the animal pupil before examining its retina

A retina checkup for a cat, his name is boji

Boji’s retina was examined using fundus explorer pro using iPhone XR

Get more retina examinations

Add your mail address

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Tadpole Pupil, Case presentation, diagnosis, examination and management https://choroida.com/tadpole-pupil-case-presentation-diagnosis-examination-and-management.html Tue, 06 Apr 2021 13:21:02 +0000 https://choroida.com/?p=9207 Tadpole Pupil case report A 33-year-old lady presented complaining of an intermittently irregular right pupil. The pupil distortion usually lasted for a few minutes and, despite being painless, was often accompanied by a vague change in periocular sensation. The symptom occurred sporadically, sometimes with several weeks in between episodes, but occasionally happening several times on [...]

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Tadpole Pupil case report

A 33-year-old lady presented complaining of an intermittently irregular right pupil. The pupil distortion usually lasted for a few minutes and, despite being painless, was often accompanied by a vague change in periocular sensation.

Tadpole Pupil

The symptom occurred sporadically, sometimes with several weeks in between episodes, but occasionally happening several times on the same day. There were no other visual symptoms and no significant past ocular history. General health was good and no regular medications were taken.

On examination,

visual acuity was normal bilaterally. There was a 1 mm right ptosis with mild anisocoria, the right pupil being 1 mm smaller in normal room illumination. In dim lighting, the discrepancy in pupillary size increased to 3 mm. Pupil reactions to light and accommodation were considered normal. No other ocular or neurological abnormalities were detected.

Phenylephrine 10% in both eyes appeared to improve the ptosis and caused more dilatation to the right pupil (7 mm compared to 4 mm on the left). A provisional diagnosis of a variant of right Horner’s syndrome was made.

A chest X-ray and magnetic resonance imaging of the brain and orbits were both normal. Some weeks later, the patient captured a picture of the pupillary distortion showing a tadpole-shaped pupil.

Tadpole pupil (also referred to as tadpole-shaped pupil) is a rare condition originally described by Thompson et al. in a series of patients who experienced brief, intermittent episodes of pupil dilation. The hallmark feature is that one segment of the iris is pulled to a peak, creating an irregular-shaped pupil, resembling the shape of a tadpole.

Tadpole Pupil

capture similar photos by your smartphone !!

Pathophysiology

Tadpole pupil pathophysiologic mechanism is unknown. A few hypotheses have been reported, but none have been proven. One hypothesis is a segmental spasm of the iris dilator muscle (not the iris sphincter muscle) occurs. This is based on observations that pupillary light response remains intact.

While..

several cases of tadpole pupils have been reported without an identifiable trigger, physical exercise and waking up from sleep have been reported, leading to the hypothesis that an increase of circulating catecholamines may play a role.

Furthermore,

the association of tadpole pupil and Horner Syndrome allows for speculation that denervation hypersensitivity plays a role.

Risk Factors

There are no known risk factors for tadpole pupils. Episodes of tadpole pupils have been associated with migraine headache, menstruation, awakening from sleep, and exercise.

Diagnosis

Tadpole pupil is a clinical diagnosis based on history and the hallmark of episodic pupillary sphincter dilation. As mentioned above, the episodes are typically brief and are more often unilateral, but can be bilateral and can rarely occur simultaneously.

Dilute pilocarpine testing can be used in the office to rule out Adie’s pupil. An exaggerated constriction post-pilocarpine would make the diagnosis of Adie’s, not tadpole pupil. On the contrary, the absence of the phenomenon along with the features listed above would support a diagnosis of the tadpole pupil.

Approximately,

42% of the patients in Thompson’s series had concurrent Horner’s syndrome. Apraclonidine testing can be performed to detect Horner’s syndrome. A normal pupil will constrict in response to Apraclonidine due to the alpha 2 agonistic properties. However, when Horner’s syndrome is present, the pupil will dilate due to the alpha 1 agonistic properties, leading to a reversal of the anisocoria.

It is also important to obtain a thorough medical history and review of symptoms in order to detect any central, second-order neuron, or third-order neuron lesion. When appropriate, imaging of the brain and/or thorax should be obtained.

The pupil will appear oval-shaped and tapered at the end most near the limbus. The tapered end can appear in any clock direction of the eye.

Take a break … read about slit-lamp smartphone photography

Tadpole Pupil

History

Episodes of pupils are typically brief. In the series by Thompson et al, episodes lasted less than five minutes in 23 of 26 patients (88%) and less than 2 minutes in 18 of 26 patients (69%). Episodes often occurred throughout the day and lasted for days to weeks. Most cases resolved spontaneously, while some patients had occasional relapses.

Eighteen of the 26 patients (69%) in Thompson’s series involved the same eye, while the other 8 patients (31%) had symptoms alternating between both eyes. Two patients in this series experienced pupillary changes of both eyes occurring simultaneously. Bilateral involvement was also reported by Hansen and Vijayaraghavan.

Physical examination

Episodes of tadpole pupil are rarely witnessed by the physician. With the modern use of cameras and camera phones, more of these episodes are being documented and reported to ophthalmologists with photographs or videos.

The clinician must pay careful attention to visual acuity, pupils (both in dark and light), assessing for uniform constriction and dilation, and assessing for any vermiform movements of the iris.

When episodes of tadpole pupil were observed by the clinician, there was poor constriction to light at the segment of dilated iris, but the remainder of the pupil constricted normally, suggesting abnormal activity of the iris dilator as opposed to iris sphincter.

Iris color should be evaluated assessing for any signs of heterochromia (i.e. Congenital Horner’s), iris atrophy (i.e. trauma), or transillumination defects. Eyelid symmetry and extraocular movements should be assessed. Color plates, confrontational visual fields, and testing of stereopsis should be performed. The dilated exam should pay careful attention to the optic nerves.

Symptoms

The following symptoms have been reported

  • Blurry vision (65%): Described as blurring, a veil, or film over the eye,
  • Peculiar feeling (38%): Described as funny sensation, a chill, and eyelash in my eye, pulling sensation
  • Headache or orbital fullness (23%)
  • Dizziness or Lightheadedness (12%)

Differential diagnosis

The differential diagnosis for tadpole pupil includes:

  • Benign episodic unilateral mydriasis
  • Horner’s syndrome
  • Adie pupil
  • Argyll Robertson Pupil
  • Unilateral exposure to mydriatic agent
  • Ocular migraine
  • Coloboma
  • Iris sphincter damage (post-traumatic or post-surgical)
  • Anterior uveitis
  • Open globe

Management and Complications

Because of the paucity of reported cases, no randomized studies have been performed on potential treatment options. Most reported cases resolved spontaneously.

Tadpole pupil requires no medical or surgical management. There are no known complications. If an associated Horner syndrome has been ruled out, patients can be reassured that episodes of tadpole pupil while bothersome to some patients will not have any long-term adverse effects on vision.

Prognosis

Long-term follow-up with these patients has not been reported in the literature. Patients usually have long-term resolution with occasional relapses. It has yet to be reported at what time interval patients begin to experience resolution of symptoms.

How to take slit-lamp exam images by a smartphone?

Smartphone slit-lamp photography is the new advancement in the field of science and technology in which the photographs of the desired slit-lamp finding can be taken with smartphones by using the slit-lamp adapters.

References

  1. Thompson HS, Zackon DH, Czarnecki JS. Tadpole-Shaped Pupils Caused by Segmental Spasm of the Iris Dilator Muscle. American Journal of Ophthalmology. 1983;96(4):467-477. doi:10.1016/s0002-9394(14)77910-3
  2. Balaggan KS. Episodic Segmental Iris Dilator Muscle Spasm. Archives of Ophthalmology. 2003;121(5):744. doi:10.1001/archopht.121.5.744
  3. Aggarwal K, Hildebrand GD. The Tadpole Pupil. JAMA Neurology. 2017;74(4):481. doi:10.1001/jamaneurol.2016.5981
  4. Hansen J, Møller H. Is Tadpole Pupil in an Adolescent Girl Caused by Denervation Hypersensitivity? Neuropediatric. 2017;48(03):185-187. doi:10.1055/s-0036-1597614
  5. Vijayaraghavan R, Philips CA, Choudhury SP. Bilateral tadpole pupils. Neurology. 2016;86(11):1074-1075. doi:10.1212/wnl.0000000000002470
  6. Kawasaki A, Mayer C. Tadpole pupil. Neurology. 2012;79(9):949-949. doi:10.1212/wnl.0b013e318266fcdd
  1. Koay KL, Plant G, Wearne MJ. Tadpole pupil. Eye. 2004;18(1):93-94. doi:10.1038/sj.eye.6700513

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Roth Spots, Case presentation, causes, examination and management https://choroida.com/roth-spots-case-presentation-causes-examination-and-management.html Mon, 29 Mar 2021 11:27:49 +0000 https://choroida.com/?p=9255 Roth spots case report A 46-year-old man presented with a four-week history of progressive bilateral visual loss. He also reported malaise, fever, anorexia, and night sweats, and had lost 14 kg in weight. He denied any history of exposure to HIV-related risk factors. Visual acuities at presentation were 6/36 in each eye with quiet anterior [...]

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Roth spots case report

A 46-year-old man presented with a four-week history of progressive bilateral visual loss. He also reported malaise, fever, anorexia, and night sweats, and had lost 14 kg in weight. He denied any history of exposure to HIV-related risk factors.

Visual acuities at presentation were 6/36 in each eye with quiet anterior segments.

Dilated fundoscopy revealed multiple white-centered hemorrhages and large premacular hemorrhages. There was no associated vitritis or retinitis/vasculitis.

Physical examination revealed a grade III pan systolic murmur, hepatosplenomegaly, cervical and axillary lymphadenopathy, and borderline pyrexia of 37.7°C. There were no splinter hemorrhages or nail bed infarcts.

By examining fundus, Roth Spots were found central and adjacent to both arcades, Fundus image was taken at the best quality as following ;

Based on the previous history and examination, what will be your differential diagnosis to such a case?

Let’s know more in-depth about Roth spots sign,… Then we will get back to differential diagnosis.

Roth Spots are defined as a white-centered retinal hemorrhage and are associated with multiple systemic illnesses, most commonly bacterial endocarditis. Originally described by Moritz Roth in 1872 while at the University of Basel,



Roth spots were first seen in individuals with bacteremia secondary to subacute bacterial endocarditis. The retinal findings Roth made in 1872 were described as round, oval, or flame-shaped hemorrhages with a central white spot.

Although originally described by Roth, Roth spots earned their name only later by the (biologist) Litten in 1878. Litten made more detailed observations of these entities and claimed they appeared in approximately 80% of cases of subacute bacterial endocarditis, thus cementing the hallmark association.

However,,

they can be seen in a wide variety of conditions, and more recent research has found that only 2% of patients with endocarditis had Roth spots present on their retina.

Though Roth spots are usually thought of as pathognomonic for bacterial endocarditis, they can occur in a number of conditions.

Fundus Examinaion - Fundoscopy

Risk Factors

Risk factors for subacute bacterial endocarditis include IV drug use, immunodeficiency, poor dentition or dental infection, structural heart disease, valvular disease, and prosthetic valves.

The presence of underlying disease-promoting abnormal retinal blood vessels (e.g., diabetes and hypertension) is linked to the development of Roth spots. Patients with a genetic predisposition to leukemia/ lymphoma are at higher risk of developing Roth spots.

Pathophysiology

A series of investigations beginning in the 1960s demonstrated that the white center of Roth spots represents a fibrin thrombus, platelet aggregates, and infiltrating red blood cells at the site of a previous vessel rupture.

These findings resulted in a more coherent understanding of the pathogenesis of Roth spots. Specifically, rupture of retinal capillaries results in the extrusion of whole blood and subsequent platelet adhesion to the damaged endothelium.

The resulting coagulation cascade then results in a platelet-fibrin thrombus, which results in the pale lesion appearing at the center of the hemorrhage red lesion.



Histopathology

Roth believed these spots represented disseminated embolic foci of bacterial abscesses originating from infective vegetation on heart valves. Early investigators into the histopathology of Roth spots were surprised by the lack of leukocytes in the white center of the lesions examined in patients who died of sepsis.

Instead,,

they discovered these areas showed faint cellular staining, indefinite boundaries of the capillary endothelium, and diffuse hyaline changes.

Roth’s initial suspicion that these represented foci of the bacterial abscess were thus called into question in light of these histopathological findings. It is now believed that Roth spots are the result of retinal capillary rupture and intraretinal hemorrhage.

A common thread found in the conditions associated with Roth spots ..

Which is a predisposition for endothelial dysfunction allowing for retinal capillary disruption. Histological examination reveals that the white-centered lesions are composed mostly of fibrin, which represents extravasation and a fibrin-platelet plug at the site of vessel rupture. 

Primary prevention for cases with Roth Spots

Roth spots alone are largely asymptomatic. Visual disturbance due to Roth spots is rare but can occur with macular involvement.

Detection of Roth spots on fundoscopy can be a sign of underlying disease, and if found incidentally, referral to a primary care physician or internist for evaluation and work-up of systemic disease is suggested.

Medical History

As Roth spots are non-specific ophthalmic findings, a thorough history should be taken with particular attention to the past medical history of :

  • prior infections
  • cardiac history (e.g., prosthetic heart valves)
  • dental history
  • IV drug use
  • immunodeficiency
  • other chronic conditions including diabetes, hypertension, anemia, and known hematologic disorders.

A full review of systems related to infective endocarditis and bleeding disorders such as fevers, chills, night sweats, unexplained weight loss, fatigue, abnormal bleeding or bruising, and shortness of breath should be reviewed.

Physical examination

Roth spots are signs of systemic illness and the patient’s vital signs and overall hemodynamic stability should be assessed.

On fundoscopic exam, Roth spots will appear as round flame-shaped hemorrhage with a white/pale center (variable in size), commonly in the posterior pole.

Full dilated exam with scleral depression evaluating for other retinal abnormalities that may accompany Roth spots may give insight into the underlying disease process (e.g., other signs of diabetic retinopathy).

If suspicious for endocarditis, additional possible ophthalmic findings on a complete eye exam include conjunctival hemorrhage, retinal hemorrhage, cotton-wool spots, retinal infarction, chorioretinitis, and rarely endophthalmitis.

Non-ophthalmic exam findings include Janeway lesions, Osler nodes, splinter hemorrhages, petechiae, and cardiac murmurs.

Digital clubbing, the presence or absence of splenomegaly, and respiratory abnormalities can help point towards leukemia as the underlying disease.

Diagnosis/Testing

The initial evaluation is based largely on a thorough history, review of systems, and physical exam.

If there is clinical suspicion for endocarditis, lab work should include CBC with differential, erythrocyte sedimentation rate, C-reactive protein, and blood cultures should be drawn, with antibiotic treatment started immediately after blood cultures are taken.

A transthoracic echocardiogram should be obtained to evaluate for definitive signs such as vegetations.

Tests such as peripheral blood smears should be obtained if history and physical raise clinical suspicion for leukemias, lymphomas, anemias, thrombocytopenia, etc.

HIV antibody testing should be done if the patient has any risk factors or suggestive findings on history or physical exam.

If carbon monoxide poisoning is suspected quantification by co-oximetry of a blood gas sample should be obtained.

HgB A1C and plasma glucose should be performed if there is any clinical suspicion of diabetes mellitus.

Multimodal Imaging

spectral-domain optical coherence tomography (SD-OCT) shows that Roth spots affect the inner retina, with thickening of the nerve fiber layer (NFL) and hyperreflective deposits below the internal limiting membrane (ILM) that cause a shadowing effect.

These hyperreflective deposits are thought to represent the fibrin-plate hemostatic complex.

On fundus autofluorescence (FAF) and fluorescein angiography (FA), Roth spots will demonstrate hypo autofluorescence and hypofluorescence due to blockage similar to other types of intraretinal hemorrhages.

Differential diagnosis for Roth spots.

DD for Roth spots signs includes :

  • Subacute bacterial endocarditis
  • Leukemia
  • Myeloma
  • Anemia
  • Anoxia
  • Carbon monoxide poisoning
  • Prolonged intubation during anesthesia
  • Preeclampsia
  • Hypertension
  • Diabetic retinopathy
  • HIV retinopathy
  • Vitamin B12 deficiency
  • Complicated labor and traumatic delivery in mothers and neonates
  • Shaken baby syndrome
  • Intracranial hemorrhage from arteriovenous malformation or aneurysm
  • Acute reduction of intraocular pressure following trabeculectomy

Management of a case with Roth spots

Roth spots are generally asymptomatic and typically resolve with treatment of the underlying disease. Treatment should be directed towards the underlying process.

Do you remember the case presentation that we have made earlier on this page?

Based on the previous knowledge you have gained, what will be your differential diagnosis for such case? how would you manage it? let us know in the comments section..

Sharing this page with colleagues will provide more educational and fruitful discussion.

would you have the interest to take retina images by a smartphone?

Fundus photography is superior to fundus analysis as it enables intraocular pathologies to be photo captured and encrypted information to be shared with colleagues and patients.

Recent technologies allow smartphone-based attachments and integrated lens adaptors to transform the smartphone into a portable fundus camera.

References

  1. Roth M. Uber netzhautuffecstionen bei wundfiebrin. [Retinal manifestations of wound fever.] DeutschA Chir 1872;1:471-84.
  2. Ling R, James B. White-centred retinal hemorrhages (Roth spots). Postgrad Med J. 1998;74(876):581–582. doi:10.1136/pgmj.74.876.581
  3. Litten M. Ueber akute maligne endocarditis und die dabei vorkommenden retinal veranderungen. Charite-Ann 1878;3:135.
  4. Loughrey PB, Armstrong D, Lockhart CJ. Classical eye signs in bacterial endocarditis. QJM. 2015;108(11):909–910. doi:10.1093/qjmed/hcv055
  5. Mostaghim, Anahita S, et al. “A Retrospective Epidemiologic Study to Define Risk Factors, Microbiology, and Clinical Outcomes of Infective Endocarditis in a Large Tertiary-Care Teaching Hospital.” SAGE Open Medicine, vol. 5, 2017, p. 205031211774177., doi:10.1177/2050312117741772.
  6. Touger M, Gallagher EJ, Tyrell J. Relationship between venous and arterial carboxyhemoglobin levels in patients with suspected carbon monoxide poisoning. Ann Emerg Med. 1995. April;25(4):481–3.
  7. Zehetner C, Bechrakis N. White centered retinal hemorrhages in Vitamin B12 deficiency anemia. Case Rep Ophthalmol. 2011;2:140-144
  8. Veronese C, et al. Multimodal ophthalmic imaging of Staphylococcus aureus bacteremia associated with chorioretinitis, endocarditis, and multifocal brain abscesses. Am J of Ophthalmol Case Rep. March 2020; 17:100577
  9. Bernardes Filho F, Machado CC, Queiroz RM, Nery B. Hallmark Cutaneous Signs of Infective Endocarditis The Journal of Emergency Medicine. 2018; 54(6):876-877.

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Christmas tree cataract https://choroida.com/christmas-tree-cataract.html https://choroida.com/christmas-tree-cataract.html#comments Mon, 08 Mar 2021 09:50:10 +0000 https://choroida.com/?p=9123 A 60 years old female presented for a routine eye check-up. Her best-corrected visual acuity was 6/6 in both eyes. Slit-lamp examination after pupillary dilatation displayed vivid multi-colored glistening opacities in the otherwise clear lens of her left eye (Fig. 1A). A magnified view using direct focal illumination revealed a spectacular array of polychromatic needle-shaped [...]

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A 60 years old female presented for a routine eye check-up. Her best-corrected visual acuity was 6/6 in both eyes. Slit-lamp examination after pupillary dilatation displayed vivid multi-colored glistening opacities in the otherwise clear lens of her left eye (Fig. 1A).

A magnified view using direct focal illumination revealed a spectacular array of polychromatic needle-shaped crystals traversing all directions and cutting across the natural limits of the lens fibers, located in the deep cortex and anterior nucleus of the lens, giving the appearance of colored lights decorating the branches as on a Christmas tree (Fig. 1B).

The colors of the crystals varied according to the angle of the incident light. In retro illumination, only a dim outline of the cataract was seen. The right eye examination was unremarkable. The patient had no other notable ocular or systemic abnormality.

Figure 1

(A) Glistening opacities visible in the lens of the left eye on diffuse illumination. (B) A magnified view using direct focal illumination showed multiple polychromatic needle-shaped crystals traversing all directions, cutting across the natural limits of the lens fibers.

Introduction

      Christmas tree cataract also called a starry cataract, is a rare type of opacity in the crystalline characterized by polychromatic needle-shaped deposits in the deep cortex and nucleus thereof which may be isolated or associated with other opacities. It is presented unilaterally or asymmetrically bilaterally.

There are controversies regarding the composition of said opacities. Hayes and Fisher state that the images formed are the result of light diffraction when reflected in the cells of the crystalline.

Pau and Förster suggest that the composition of the opacities would mostly be cholesterol. Shun-Shin et al.suggested cystine as the substance related to the formation of the Christmas tree opacities typical of cataract.

Discussion

       Cataracts in the Christmas tree are a rare form of opacity in the crystalline in which images similar to highly refringent multicolored needles can be seen crossing the fibers in the deep layers of the cortex.

This type of change has already been the subject of several clinical discussions, and the composition of said opacities is still controversial.

The colors vary according to the angle of incident light and the colors red and green are predominant, which explains its nomenclature since the brightness and variety of colors refer to the ornaments that commonly decorate the Christmas tree.

There are case reports of the association between cataracts in the Christmas tree and myotonic dystrophy, also called Steinert’s disease, which is characterized by a delay in muscle relaxation after a volunteer effort (myotomy).

It is a dominant autosomal inheritance and is presented as a common ophthalmologic finding, as well as the early onset of starry cataract, ptosis. Other unusual ophthalmologic findings include external ophthalmoplegia, dissociation of combined pupillary reflexes, light pigmentary retinopathy, and reduced intraocular pressure.

Clinical

Typically there are no associated pathologies to Christmas tree cataracts and most patients who have it are fit and well. However, it is frequently observed in people who suffer from Steinert’s disease which is a type of myotonic dystrophy. In either case, the opacity offers no threat to visual acuity.

They may develop a little over time but surgery is avoided where possible as the reflective properties of the opacity impair the view of the surgeon when performing the procedure.

How to take slitlamp exam images by a smartphone ?

Smartphone slit-lamp photography is the new advancement in the field of science and technology in which the photographs of the desired slit-lamp finding can be taken with smartphones by using the slit-lamp adapters.

References

  1. Brown NP, Bron AJ. Lens disorders: a clinical manual of cataract diagnosis. 3rd ed. Oxford: Butterworth-Heinemann; 1996.
  2. 2Kobayashi Y, Suzuki T. The aging lens: ultrastructural changes in cataract. In: Bellows JG, editor. Cataract and abnormalities of the lens. New York: Grune & Stratton; 1975. p. 313-43.
  3. Hayes BP, Fisher RF. Ultrastructural appearances of a lens with marked polychromatic lustre: evidence for diffraction as a cause. Br J Ophthalmol. 1984;68(12):850-8.
  4. Pau H, Förster H. [Double refraction of crystals in the lens (spheroliths, ‘Christmas tree ornaments’) and in the vitreous body (scintillatio nivea)]. Graefes Arch Clin Exp Ophthalmol. 1982;219(6):295-7. German.
  5. Shun-Shin GA, Vrensen GF, Brown NP, Willekens B, Smeets MH, Bron AJ. Morphologic characteristics and chemical composition of Christmas tree cataract. Invest Ophthalmol Vis Sci. 1993;34(13):3489-96.
  6. Kanski JJ. Oftalmologia clínica: uma abordagem sistemática. 5a ed. Rio de Janeiro: Elsevier; 2004. p. 161-91.
  7. Reggi JR, Dantas MC, Dantas PE, Borges MJ. Catarata traumática: estudo de 60 casos. Arq Bras Oftalmol. 1997;60(5):489-92.
  8. Paranhos FR. Estudo da incidência de catarata estelar em pacientes em uso de clorpromazina. Arq Bras Oftalmol. 1991;54(2):63-8.
  9. Stevens P, Swann PG. Christmas tree cataract. Clin Exp Optom. 1998;81(3):98

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smartphone slit-lamp photography https://choroida.com/smartphone-slit-lamp-photography.html https://choroida.com/smartphone-slit-lamp-photography.html#comments Sat, 06 Mar 2021 21:55:35 +0000 https://choroida.com/?p=9151 Smartphone slit-lamp photography is the new advancement in the field of science and technology in which the photographs of the desired slit-lamp finding can be taken with smartphones by using the slit-lamp adapters. The smartphone slit-lamp photography allows for photo documentation of any ocular pathology. It has a fully embedded system capable of storing and [...]

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Smartphone slit-lamp photography is the new advancement in the field of science and technology in which the photographs of the desired slit-lamp finding can be taken with smartphones by using the slit-lamp adapters.

The smartphone slit-lamp photography allows for photo documentation of any ocular pathology. It has a fully embedded system capable of storing and analysis of ocular images.

The images and videos can be directly transmitted from the phone via wireless telecommunication.

It helps in communication between eye care professionals to discuss a particular pathological case.

It plays a key role in keeping up the patient records and in-patient education.

It is useful in recording videos especially fundus and gonioscopy, specular photographs.

Although,

smartphone photography can be done with bare hands. But this method requires steady hands and is troublesome to some extent. The alternatives are adapters. These are available to buy online at our website. They make it easier to do smartphone slit-lamp and surgical photography and video recording through the eyepiece of microscopes.

Choroida Slitlamp Adaptor

Specifications:

  • Simple, easy & affordable
  • suitable for all mobile phones
  • suitable for heavy devices like tablets.
  • 3D Printed.
  • portable, lightweight
  • block flashlight to depend on slit-lamp lightening only.
  • adjustable for many sizes.

Photos taken by Choroida slit-lamp adaptor:

Choroida slit-lamp adaptor for 10X, 12X & 12.5X eyepieces.

 

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How to get Choroida Slitlamp Adaptor https://choroida.com/how-to-get-choroida-slitlamp-adaptor.html https://choroida.com/how-to-get-choroida-slitlamp-adaptor.html#comments Thu, 25 Feb 2021 22:12:27 +0000 https://choroida.com/?p=9075 To get choroida Slitlamp Adaptor, just follow these few steps: 1.Visit choroida.com and choose choroida innovative products. 2.Choose Slitlamp adaptor – variable sizes. 3.From the eyepiece list, choose between two options (10X or 12X,12.5X). ** Please Check your SL eyepiece before making this purchase. Eyepieces are either 10X, 12X or 12.5X. ** 4. Click add to [...]

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To get choroida Slitlamp Adaptor, just follow these few steps:

1.Visit choroida.com and choose choroida innovative products.

2.Choose Slitlamp adaptor – variable sizes.

3.From the eyepiece list, choose between two options (10X or 12X,12.5X).

** Please Check your SL eyepiece before making this purchase. Eyepieces are either 10X, 12X or 12.5X. **

4. Click add to cart.

5.On the shipping cart page, add your discount coupon (if you have one) and proceed to checkout.

6.Fill in your shipping info and check the option to create your account (to be able to track your shipment).

then the shipping fees shall be calculated automatically according to your provided shipping address.

7.Choose the suitable payment gateway (PayPal or credit card).

8.Place your order.

Now your order shall be placed successfully.

* We ship and deliver to all countries via FedEx, express service, door to door delivery.

* Order processing time: 2-3 business days.

* Estimated delivery time to most countries: 5-7 business days.

* A notification of estimated delivery time will be sent to your email once the order is placed.

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Retinal imaging by your smartphone https://choroida.com/retinal-imaging-by-your-smartphone.html Thu, 25 Feb 2021 22:06:33 +0000 https://choroida.com/?p=9021 The most critical aspect of eye care practice is the Fundus examination. Fundus photography is superior to fundus analysis as it enables intraocular pathologies to be photo captured and encrypted information to be shared with colleagues and patients. Recent technologies allow smartphone-based attachments and integrated lens adaptors to transform the smartphone into a portable fundus [...]

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The most critical aspect of eye care practice is the Fundus examination. Fundus photography is superior to fundus analysis as it enables intraocular pathologies to be photo captured and encrypted information to be shared with colleagues and patients.

Recent technologies allow smartphone-based attachments and integrated lens adaptors to transform the smartphone into a portable fundus camera.

Although,

traditional fundus cameras provide Digital images with High Quality and provide Different modes to view different retinal areas and it is Good with hazy media,

But they are:

  • very expensive.
  • non portable.
  • need skills and training.
  • have problems with convenience and portability.

In contrast,

smartphones are readily available, relatively inexpensive, and easy to operate. It has a fully embedded system capable of acquisition, storage, and analysis of fundus images that can be directly transmitted from the phone via the wireless telecommunication system for remote evaluation.

Smartphone ophthalmoscope :

The smartphone camera can be used as a portable ophthalmoscope when used in conjunction with a +20D condensing lens. The flash should be turned on to illuminate and view the fundus.

  • Portable
  • Very easy usage
  • Wide compatibility with phones “compatible with android and IOS devices”
  • Wide compatibility with indirect lenses: “Volk, Heine, Ocular, Nikon, Indian”
  • The lowest cost. 
Choroida Fundus Explorer
Choroida Fundus Explorer

Photos and videos taken by Choroida Fundus Explorer :

 

Full fundus examination via Choroida fundus explorer.

Choroida fundus explorer (installation, specifications, lenses compatibility).

 

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How to get Choroida fundus explorer https://choroida.com/how-to-get-choroida-fundus-explorer.html Thu, 25 Feb 2021 08:14:24 +0000 https://choroida.com/?p=9046 To get choroida fundus explorer, just follow these few steps:  1.Visit choroida.com and choose choroida innovative products. 2.Choose Fundus Explorer suitable with indirect fundus lenses. 3.From the lens list, choose between two options (with built-in 22D lens or without lens). 4.From the compatibility list, choose which lens you want your device to be compatible with [...]

The post How to get Choroida fundus explorer appeared first on Choroida.

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To get choroida fundus explorer, just follow these few steps: 

1.Visit choroida.com and choose choroida innovative products.

2.Choose Fundus Explorer suitable with indirect fundus lenses.

3.From the lens list, choose between two options (with built-in 22D lens or without lens).

4.From the compatibility list, choose which lens you want your device to be compatible with (lens you already have).

**the package doesn’t include a separate 20D Aspheric lens **

5.click add to cart.

6.On the shipping cart page, add your discount coupon (if you have one) and proceed to checkout.

7.Fill in your shipping info and check the option to create your account (to be able to track your shipment)

then the shipping fees shall be calculated automatically according to your provided shipping address

8.choose the suitable payment gateway (PayPal or credit card).

9.place your order.

Now your order shall be placed successfully.

* We ship and deliver to all countries via FedEx, express service, door to door delivery.

* Order processing time: 2-3 business days.

* Estimated delivery time to most countries: 5-7 business days.

* A notification of estimated delivery time will be sent to your email once order is placed.

The post How to get Choroida fundus explorer appeared first on Choroida.

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Rosette-Shaped Cataract https://choroida.com/rosette-shaped-cataract.html https://choroida.com/rosette-shaped-cataract.html#comments Wed, 17 Feb 2021 22:34:36 +0000 https://choroida.com/?p=9005 A 56-year-old male patient went to an outpatient department (OPD) with complaints of diminution of vision in the left eye for the last 1 year. He gave no history of any glare or difficulty at night. He did not have any relevant past history of any trauma (blunt or subtle, even after repeated questioning) nor [...]

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A 56-year-old male patient went to an outpatient department (OPD) with complaints of diminution of vision in the left eye for the last 1 year. He gave no history of any glare or difficulty at night. He did not have any relevant past history of any trauma (blunt or subtle, even after repeated questioning) nor of any ocular or systemic disease. He gave no significant personal history, was not a smoker, or gave no drug addiction history. He was a spectacle wearer using a bifocal with distance correction +1.00 Dioptre Sphere (DS) in both eyes and a near correction of +2.50DS in both eyes. His best-corrected visual acuity (BCVA) was right eye (oculus dexter) (OD) 6/6, N6, and left eye (oculus sinister) (OS) 6/18, N6. On examination, he was found to have a “double rosette cataract” in the left eye, with early lens changes in the right eye. Gonioscopy, indirect ophthalmoscopy, and ultrasound biomicroscopy (UBM) were carried out to rule out any signs of subtle trauma and revealed no significant abnormality. The remaining examination did not reveal any significant findings. Furthermore, on examining his sibling and children no signs of any developmental cataract or similar lens abnormalities were noted. Suggesting that there was no significant family history suggestive of a similar “double rosette cataract,” thereby ruling out any familial or hereditary traits.

Diffuse illumination view of the left eye's double rosette cataract
Diffuse illumination view of the left eye’s double rosette cataract
Retroillumination view of the left eye's double rosette cataract
Retroillumination view of the left eye’s double rosette cataract
Slit lamp view of the left eye's double rosette cataract
Slit-lamp view of the left eye’s double rosette cataract.

Another case of Rosette Cataract on slit-lamp [3]

Discussion

Rosette or stellate-shaped cataracts are associated with blunt injury of the eye.[] the patient gave no such history of any trauma, any systemic illness, metabolic disease, drug use, or any other significant history leading to this type of cataract. Rosette cataracts are also associated with diabetes mellitus.[]

Conclusion

Double rosette type of cataract with no history of any trauma or systemic illness has never been reported in the literature before. This is a case of a double rosette cataract found incidentally.

References

1. Fyodorov SN, Egorova EV, Zubareva LN. 1004 cases of traumatic cataract surgery with implantation of an intraocular lens. J Am Intraocular Implant Soc. 1981;7:147–53. [PubMed[]
2. Ramkumar H, Basti S. Reversal of bilateral rosette cataracts with glycemic control. ScientificWorldJournal. 2008;8:1150–1. [PMC free article] [PubMed[]
3. Sharjeel Eye youtube channel, https://www.youtube.com/watch?v=unH2c5b_DYQ

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Slit lamp Exam: how to use a slit lamp to check all aspects of eye https://choroida.com/slit-lamp-exam-how-to-use-a-slit-lamp-to-check-all-aspects-of-eye.html Sat, 25 Jan 2020 08:04:51 +0000 https://choroida.com/?p=7609 Slit lamp exam is the most important part to detect any abnormality or disease during eye examination.  How to do a slit lamp exam Patient should be positioned comfortably with his chin resting on chin rest and forehead opposed to head rest. The height of the table housing the slit lamp should be adjusted according [...]

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Slit lamp exam is the most important part to detect any abnormality or disease during eye examination. 

How to do a slit lamp exam

How to use a slit lamp

  • Patient should be positioned comfortably with his chin resting on chin rest and forehead opposed to head rest.
  • The height of the table housing the slit lamp should be adjusted according to patient’s height.
  • The microscope and illumination system should be aligned with the patient’s eye to be examined.
  • Focus the microscope by
    1. Adjusting the interpupillary distance
    2. Adjusting the eyepieces (set at 0 or dial in your refraction)
    3. Set magnification in on 1x
  • Move the microscope up and down, in or out or latterly byjoystickso that the tissue that is of interest comes clearly into view.
  • Adjust the illumination or brightness through the desired filters.
  • Adjust the width and height of the beam.

Start systematic examination of eye from front to the back as follow :

1. Eye lid margin

Slit lamp beam is widened to a full circle to illuminate the front of eye. Thus the anterior border shows the eyelashes projecting in two or three rows and its posterior border is sharp and resting against theeyeball. There are small orifices of the tarsal glands just in front of the lid margin and the lacrimal papilla.

2. Conjunctiva:

  • Palpebral:This structure is seenby everting the eyelids, it is a thin, transparent mucous membrane lining the inner surface of the eyelid.
  • Bulbar:This structure is examined by holding the lids open and asking the patient to look to the right, left, up, and down. Here again the conjunctiva is seen as a thin, transparent mucous membrane. A superficial, bright red system of anastomosing vessels can be easily identified in the bulbar conjunctiva.

3. Cornea:

It is the transparent layer. When the slit-lamp beam passes through the cornea, it is possible to recognize the anterior and posterior surfaces and the corneal stroma.

4. Sclera:

slit lamp exam to the sclera is extremely important to check any presence of subconjuctival hge or marks of previous procedures like trabeculotomy for Glaucoma patients

5. Anterior chamber:

Normally the anterior chamber filled with aqueous appears optically empty and black. If the slit beam is narrowed to a fine pencil of light, a very faint relicense can be made out along the course of the light. Angle of anterior chamber is assessed by gonioscopy.

6 .Iris and pupil:

Iris is the colored part of eye. In the centre there is an opening known as pupil. It controls the amount of light going into the eye by the constriction and dilation of pupil.

7. Lens:

Check whether the lens is transparent or cloudy (cataract).

8. Vitreous body

Itis just posterior to the lens. In the vitreous of aged patients, other condensations can be seen; these are thought to represent areas of degeneration.

Other usage of slit lamp with accessory devices 

1. Fundus examination:

Fundus examination can be performed by placing an additional handheld 78D or 90D lens in front of the eye. Normally the fundus has a red appearance, the optic disc is pink, round or oval shaped with sharp margins. Macula is situated 3 mm temporally to the optic disc. It is small circular area, deeper red than the surrounding fundus, there is a bright foveal reflex in the Centre. The normal artery: vein ratio in fundus is 2:3.

2. Applanation tonometry:

The IOP can be measured in slit lamp exam with the help of Goldman applanation tonometer.  An applanation tonometer measures the IOP by flattening the cornea overa specific area (3.06mm).

  • Method:

Anaesthetize the cornea and stain the tear film with fluorescein. Patient is seated in front of a slit lamp and the cornea and biprisms are illuminated with cobalt blue light from the slit-lamp. Biprism is then advanced until it just touches the apex of cornea. At this point two fluorescent semicircles are viewed through the prisms. The applanation force against the cornea is adjusted until the inner edges of the two semicircles just touch. The IOP is determined by multiplying the dial reading with 10.

3. Gonioscopy:

The angle of the anterior chamber of the eye cannot be seen by direct inspection because of the light rays arising from the angleundergo total internal reflection on reaching the curved surface of the cornea. The use of a special contact lens, a source of focal illumination, and a microscope or slit lamp makes the angle accessible. The contact lens eliminates the corneal curve and allows light to be reflected from the angle.

Slit lamp photography

Slit-lamp photography can be done by attaching the smartphones to slit-lamp by using slit lamp adaptors. a slit lamp adaptor has two parts, one part holds the smartphone, whereas the other part fixes onto the eyepiece of the slit lamp. There are different types of slit-lamp adaptors according to the eyepiece of the slit-lamp:

  • 10x eyepiece adaptors
  • 12x eyepiece adaptors

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