A smartphone fundoscope is a device that uses a phone camera, lens, and a light source to capture images of the retina, the innermost layer of the eye. These images can be used to detect a variety of ocular conditions, such as diabetic retinopathy, age-related macular degeneration, and glaucoma. The non-invasive nature of this technology makes it an attractive option for healthcare professionals and patients alike.

One of the most significant advancements in smartphone fundoscopes is the integration of artificial intelligence (AI) and machine learning algorithms. AI algorithms can be trained to automatically detect ophthalmic signs in retinal images. This can lead to faster and more accurate diagnoses, as well as increased efficiency in the healthcare system.

For example, AI algorithms can be trained to detect the presence of diabetic retinopathy, a condition that can lead to blindness if left untreated. By analyzing retinal images, AI algorithms can identify characteristic signs of diabetic retinopathy, such as blood vessel abnormalities and hemorrhages. This can significantly improve the accuracy and speed of diagnoses, allowing for earlier treatment and potentially avoiding vision loss.

Another exciting development in the field of smartphone fundoscopes is the integration of virtual reality (VR) and augmented reality (AR) technologies. For example, VR and AR can be used to create immersive and interactive educational experiences for patients, helping to improve patient understanding and engagement with their ocular health. In addition, VR and AR can be used to assist healthcare professionals in the interpretation of retinal images, making it easier to identify ocular conditions and plan appropriate treatments.

Finally, the future of smartphone fundoscopes will also be shaped by the continued development of cloud-based systems and big data analytics. This will allow for the centralized storage and analysis of large amounts of retinal images, making it easier to detect patterns and trends in ocular health. This can be particularly useful in large-scale studies and in monitoring the progression of ocular conditions over time.

These advancements have the potential to greatly improve the accuracy and speed of diagnoses, as well as to increase efficiency in the healthcare system. By continuing to push the boundaries of what is possible with smartphone fundoscopes, we can transform the field of ophthalmology and improve the lives of millions of people around the world.

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• Compatibility: The first and most important factor to consider when choosing a smartphone fundoscope is compatibility. Make sure that the device is compatible with the type of smartphone you currently use or plan to use in the future. This will ensure that you can easily connect the device to your phone and start using it right away. It’s important to check the device’s compatibility with your phone’s operating system, as well as the size of the device’s connector to ensure a snug fit.

• Image quality: The quality of the images produced by the fundoscope is critical for accurate diagnosis. Look for a device that has a wide field of view, as well as the ability to adjust the focus. This will enable you to see fine details of the fundus.

• Durability: A fundoscope that is built to last will save you money in the long run. Look for a device that is made of high-quality materials and is designed to withstand frequent use. Check for the device’s design and construction.

• Ease of use: A fundoscope that is easy to use will save you time and reduce the risk of errors. Look for a device that is user-friendly and easy to set up and operate. A device that is easy to set up and operate will reduce the time it takes to get started.

• Price: Of course, the cost is always a consideration when making a purchase. Look for a device that is reasonably priced and offers good value for the money. Keep in mind that the price of a device may not always reflect its quality or performance. It’s important to research the device’s features and read reviews before making a purchase.

• The reputation of the supplier: It’s important to choose a reputable supplier for your smartphone fundoscope. A reputable supplier will provide you with a device that is of high quality and can offer customer support when needed. It’s also important to look for a supplier who can provide you with additional accessories such as replacement parts.

In conclusion, choosing the right smartphone fundoscope for your medical practice requires careful consideration of various factors such as compatibility, image quality, durability, ease of use, price, and reputation of the supplier. By considering these factors, you will be able to choose a device that is the right fit for your practice.

and will enable you to improve the accuracy of your diagnoses and provide better care for your patients.

One device that stands out as a great option for a smartphone fundoscope is the Fundus Explorer Pro. This device is compatible with all smartphones and has a wide field of view (More than 60° Field of View ), allowing you to see fine details of the fundus with ease. The Fundus Explorer Pro is built to last, with durable construction and design.

One of the most appealing features of the Fundus Explorer Pro is its ease of use. The device is easy to set up and operate, saving you time and reducing the risk of errors.

In terms of price, the Fundus Explorer Pro is reasonably priced and offers good value for the money. Additionally, the supplier is reputable and can provide you with additional accessories such as replacement parts, or extra batteries.

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One of the most significant impacts of smartphone fundoscopy on patient outcomes is the ability to diagnose and treat eye diseases earlier. Ophthalmologists can quickly capture high-quality images and make a diagnosis on the spot, leading to earlier treatment and better outcomes.

Another impact of smartphone fundoscopy on patient outcomes is the ability to provide eye care services to remote and underserved areas. Traditional funduscopes are large and bulky devices that require significant investment and ongoing maintenance.

In contrast, smartphone fundoscopes are small and lightweight, making them easy to transport and use in a variety of settings. This is particularly beneficial for patients living in remote or underserved areas, as it allows them to receive eye care services that they otherwise might not have access to.

The use of smartphone fundoscopy also allows for improved collaboration and communication among healthcare providers. With traditional funduscopy, images would have to be manually sent to other healthcare professionals for consultation or review. With smartphone fundoscopy, images can be easily stored on the phone or in the cloud and can be easily shared with other healthcare professionals which also increases the learning curve.

This can lead to improved collaboration and communication among healthcare providers, and can ultimately lead to better patient outcomes.

In addition, smartphone fundoscopy is a great tool for telemedicine. With the rise of telemedicine, more and more patients are being seen remotely, and smartphone fundoscopy can be an ideal way to provide remote eye care. Patients can have their eyes examined remotely by an ophthalmologist and have high-quality images sent to the ophthalmologist for review.

This can greatly improve patient access to eye care services and can be especially beneficial for patients living in remote or underserved areas. While smartphone fundoscopy has many benefits, it is important to note that it should not be used as a replacement for traditional funduscopy.

Traditional funduscopy is still the gold standard for eye exams and should be used when possible. Smartphone fundoscopy should be used as an adjunct to traditional funduscopy, and only when traditional funduscopy is not possible or practical.

In conclusion, the use of smartphone fundoscopes can have a significant impact on patient outcomes. It allows for earlier diagnosis and treatment, improved access to eye care services in remote and underserved areas, improved collaboration and communication among healthcare providers, and the ability to provide remote eye care through telemedicine.

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This technology has the potential to revolutionize the way ophthalmologists diagnose and treat eye diseases, particularly in remote and underserved areas.

One of the biggest advantages of smartphone fundoscopy is its convenience and portability. Traditional fundoscopes are large and bulky devices that require significant investment and ongoing maintenance. In contrast, smartphone fundoscopes are small and lightweight, making them easy to transport and use in a variety of settings.

This is particularly beneficial for ophthalmologists who work in remote or underserved areas, as it allows them to provide eye care services to patients who otherwise might not have access to these services.

Smartphone fundoscopy provides improved image quality compared to traditional fundoscopes. Modern smartphones are equipped with high-resolution cameras and advanced image processing capabilities that allow for the capture of clear, high-quality fundus images.

This can lead to improved diagnostic accuracy and patient outcomes, as ophthalmologists are better able to identify and treat eye diseases. Additionally, many smartphone fundoscopes have additional features such as autofocus and automatic image stabilization that further enhance the quality of the images captured.

Another advantage of smartphone fundoscopy is the ability to easily store and share images with other healthcare professionals. Traditional fundoscopes often require the use of film or specialized software to capture and store images, which can be time-consuming and expensive.

With a smartphone fundoscope, images can be easily stored on the phone or in the cloud and can be easily shared with other healthcare professionals for consultation or review. This can lead to improved collaboration and communication among healthcare providers, and can ultimately lead to better patient outcomes.

In addition, smartphone fundoscopy can be an effective tool for screening for certain eye conditions such as diabetic retinopathy and age-related macular degeneration. These conditions can be detected early on by performing regular fundus examinations, which can lead to early intervention and better outcomes.

In conclusion, smartphone fundoscopy is a valuable tool for ophthalmologists that offers many advantages over traditional funduscopy, including convenience, portability, improved image quality, and the ability to perform a self-examination. The Fundus Explorer Pro is an excellent choice for those looking to implement this technology in their practice.

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As ophthalmologists, we are constantly searching for new and innovative ways to improve our diagnostic capabilities, especially when it comes to detecting and managing glaucoma. One such technology that has recently emerged is the use of smartphone fundoscopes.

A smartphone fundoscope is a device that attaches to the camera of a smartphone and allows for high-resolution imaging of the retina. This technology has the potential to revolutionize the way we detect and manage glaucoma, as it allows for easy and convenient access to high-quality retinal images.

One of the main advantages of smartphone fundoscopes is their portability. They can be easily carried in a pocket or bag, allowing for quick and easy imaging of patients in remote or underserved areas. Additionally, their use can increase patient compliance, as patients are more likely to return for follow-up imaging if convenient.

Another advantage is that smartphone fundoscopes are relatively inexpensive compared to traditional fundoscopy equipment, making them more accessible for clinics and hospitals with limited resources.

In terms of diagnostic capabilities, smartphone fundoscopes have been shown to have a high level of accuracy in detecting glaucomatous changes in the retina, comparable to traditional fundoscopy equipment.

In addition to the advantages already mentioned, smartphone fundoscopes also have the potential to improve the efficiency and effectiveness of clinical trials for glaucoma by allowing for easy and convenient data collection from a large number of participants.

Furthermore, smartphone fundoscopes can also be integrated with other technologies such as artificial intelligence (AI) and machine learning algorithms, which can aid in the analysis of retinal images and help to identify early signs of glaucomatous damage.

However, it is crucial to consider that the quality of the image captured by smartphone fundoscopes may vary depending on the quality and resolution of the smartphone’s camera. Therefore, it is important to use smartphones with high-resolution cameras or to use high-quality external lenses to ensure that the images captured are of diagnostic quality.

It’s also important to note that using smartphone fundoscopes requires proper training and education for ophthalmologists and staff to ensure that images are captured correctly and accurately. This includes understanding how to properly position and focus the camera, how to properly light the eye, and how to properly interpret the images

In summary, smartphone fundoscopes are a valuable tool for ophthalmologists in the detection and management of glaucoma. They offer a convenient and cost-effective way to obtain high-quality retinal images and have the potential to improve the efficiency and effectiveness of clinical trials and the integration of AI and machine learning algorithms. it is important to stay informed about this technology and consider incorporating it into our practice.

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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 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.

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

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

7. Koay KL, Plant G, Wearne MJ. Tadpole pupil. Eye. 2004;18(1):93-94. doi:10.1038/sj.eye.6700513

The post Tadpole Pupil, Case presentation, diagnosis, examination and management appeared first on Choroida.

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.

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.

The post Roth Spots, Case presentation, causes, examination and management appeared first on Choroida.

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.

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.
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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.
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