The Meibomian glands, located in the tarsal plates of the eyelids, play a crucial role in producing the lipid layer of the tear film—the outermost layer of the tear film. This layer is essential for stabilizing the tear film, preventing tear evaporation, and maintaining the homeostasis of the ocular surface. Dysfunction of the Meibomian glands (MGD) disrupts tear film stability, leading to ocular surface imbalance.
MGD results from altered meibomian secretion quality, gland dropout, and/or ductal obstruction. One of the most effective tests for assessing Meibomian gland morphology is Meibography, a technique that provides in vivo visualization of these glands.
Propaedeutic evaluation of dry eye: beyond Meibography
Dry eye diagnostic tests include evaluating tear film stability and volume, ocular surface damage with vital dyes such as fluorescein or rose bengal, lid assessments, and Meibomian gland examination.
Meibography using infrared light with the Eyer2 portable fundus camera.Meibography with the Eyer2 portable fundus camera and anterior segment module.
Phelcom has recently revolutionized this field by incorporating infrared imaging into its new Eyer2 portable device, making meibography more practical. The Eyer2’s anterior segment module enables both meibography and examinations for corneal and conjunctival epithelial cell changes using cobalt blue light and fluorescein.
Corneal damage imaging with the Eyer2 fundus camera and fluorescein.
For a comprehensive dry eye diagnosis, other clinical evaluations such as the Schirmer test are recommended to differentiate between aqueous-deficient and evaporative dry eye.
Additional applications of Meibography
Meibography is also valuable in preoperative evaluations for refractive surgery, as dry eye, often linked to MGD, is a common postoperative complication. This exam provides preoperative documentation and gland monitoring, as well as patient education.
Furthermore, meibography can be utilized to assess eyelid impairment due to contact lens wear, allergic conjunctivitis reactions, antiglaucoma treatments, and other clinical conditions.
Eyer2
Phelcom proudly introduces the Eyer2, a versatile visual examination platform that delivers high-quality imaging of both the posterior and anterior segments.
This new equipment offers color and red-free fundus imaging with a new 55º field of view, along with tools for anterior segment imaging using various light sources, including cobalt blue light for corneal lesion assessment and infrared light for meibography.
Eyer2 with new anterior segment module
About Phelcom
Phelcom Technologies is a Brazilian medtech company based in São Carlos, in the interior area of São Paulo. The company’s story began in 2016, when three young researchers – a physicist, an electronics engineer and a computer engineer (physics, electronics, computing) – created a portable fundus camera integrated with a smartphone.
The first prototype project was born from Diego Lencione’s interest in visual health, as his brother has a condition that has severely compromised his retina and vision since childhood.
In 2019, Phelcom launched its first product on the Brazilian market: the Eyer portable fundus camera. Today, the technology has reached more than two million people throughout Brazil and in the countries where it is present and has been used in more than 100 community screenings.
Fontes: Wolffsohn et al. TFOS DEWS II Diagnostic Methodology report 2017 Magno et al. Hot towels: The bedrock of Meibomian gland dysfunction treatment – A review Arita. Meibography: A Japanese Perspective Reiko. 2018
The doctor Gustavo Rosa Gameiro, a PhD student in ophthalmology at Unifesp, was selected by the Brazilian Academy of Sciences (ABC) and the Ministry of Science, Technology and Innovation (MCTI) to participate in the 8th BRICS Young Scientists Forum. The event occurred from July 31th to August 8th in Gqeberha, South Africa.
BRICS is a group of five developing countries focused on mutual economic cooperation: Brazil, Russia, India, China and South Africa.
Gameiro was one of the six Brazilian scientists nominated to take part in the panel “The future of education, skills and skill sets”. The PhD student points out that education entered the BRICS agenda with great force this year. “In my presentation, we discussed applications of basic models and the use of the Eyer portable fundus camera with artificial intelligence for teaching ophthalmology based on the results of our workshops,” says the doctor, the youngest member of the Brazilian delegation at the event at 27 years old.
Gustavo Gameiro used the Eyer portable fundus camera in his project presented at the 8th BRICS Young Scientists Forum. Photo: personal archive.
Gameiro explains that the first approach to diseases such as glaucoma, Age-Related Macular Degeneration (AMD) and diabetic retinopathy in primary care is often carried out by the newly qualified clinical doctor.
“However, studies reveal that they have a huge deficit in the teaching of ophthalmology during their degree, compromising the correct approach and prognosis of these cases. This can lead to insecurity in referring or treating patients with ophthalmic complaints,” he explains.
Workshops
The workshops took place with undergraduate students from Unifesp and the Albert Einstein Israelite Institute for Education and Research and were supported by the ophthalmologists Thiago Gonçalves Martins and Paulo Schor, Gameiro’s PhD advisor. The Eyer portable fundus camera and the EyerMaps AI system were provided free of charge by Phelcom Technologies for the project.
“With the EyerMaps AI resource, which uses a heat map to highlight areas of the retina with possible alterations caused by different pathologies, we were able to teach and correct the student’s interpretation findings at the same time as captured by the fundus of the eye,” says the doctor.
“The clarity of the images is absurdly incredible. We did exams on our colleagues and we were able to see every detail of the retina, optic nerve and vessels. Transforming large, heavy devices like a fundus camera into portable ones makes the doctor’s life much easier, because we can go to the patients and achieve better results,” says Unifesp medical student Suellyn Alves, who took part in the workshop.
Gameiro goes further: “Perhaps we need to change the paradigm of only teaching students how to acquire images using ophthalmic equipment. We need to focus on how to interpret them and manage these exams, organizing them in the cloud, for example. and with the Eyer, you can easily teach interpretation and management” he says.
With the satisfactory results of the workshops, the doctor reveals his desire to expand the project and turn it into support material for teaching ophthalmology throughout Brazil.
Brazilian delegation during the 8th BRICS Young Scientists Forum. Photo: personal archive.
“Eyes to the Future” contest
Gameiro is also working on a new project at the same time: evaluating the impact and follow-up of the projects presented in the “Eyes to the Future” contest, held by the Brazilian Association of Academic Ophthalmology Leagues (ABLAO), in partnership with Phelcom and with the support of the Brazilian Ophthalmology Council (CBO).
The competition seeks to teach students and encourage leagues to develop extension activities aimed at creating educational and/or assistance projects with the objective of reducing blindness due to posterior segment pathologies. To accomplish this.Phelcom provided 20 Eyer units with access to the EyerMaps feature and the EyerCloud cloud system.
The competition selected 10 projects and the top three will receive an Eyer. “It would be very interesting if we could permanently leave a portable fundus camera with each of the 10 leagues. We’re going to work on getting sponsorship to buy the seven remaining devices,” says the doctor.
“After the Academic Leagues were selected, we spoke to ABLAO’s president Luís Sabage and realized the need to evaluate and follow up on the projects submitted. Our future goal is to increase the number of ophthalmologic leagues, medical students and patients reached by the outreach projects developed,” he explains.
Furthermore, based on the results obtained in the “Eyes to the Future” contest and the points for improvement found, Gameiro intends to structure an online ophthalmology course for medical students and general practitioners, covering basic eye examination techniques, the use of artificial intelligence platforms and the interpretation of retinography images.
The doctor points out that traditional equipment for evaluating the fundus of the eye, such as fundoscopy performed with an indirect ophthalmoscope and condenser lens, is relatively difficult to handle, requires lengthy training, has a learning curve and depends on the examiner for evaluation. Besides, most of the time it doesn’t allow photographic recording of the retina for later discussion and review.
Alternatively, there is the conventional fundus camera. However, it is expensive to purchase. “Capturing images of the retina is extremely important for more accurate assessment and for monitoring the disease and treatment. It also plays a fundamental role in the training of new professionals through the presentation and discussion of findings in a group, allowing students and doctors to compare their exams and review the results,” he says.
The Eyer portable fundus camera is an extremely advantageous option in several aspects:
It makes it easy to capture high-quality images of the retina without much prior training;
Lightweight and small (it fits in the palm of your hand);
It does not require specialized labor;
Relatively more affordable than a traditional fundus camera;
It is non-mydriatic, shortening the examination time and avoiding possible adverse effects (visual discomfort, photophobia, keratitis and increased intraocular pressure);
Through telemedicine, it sends the images to the cloud, enabling remote diagnosis.
For Gameiro, the Eyer can have a significant impact on medical education. “The device can be used by medical students as a practical learning opportunity, demonstrating clinical cases and monitoring the progression of eye diseases over time, as well as stimulating interactive discussions between students and teachers, encouraging research projects and cases and facilitating access to and recording of a wide variety of cases,” he points out.
The equipment also has on-board artificial intelligence, which can be a reliable and cost-effective option for screening retinal and optic nerve pathologies using algorithms built on extensive databases.
“These algorithm models are able to predict the risk of alteration and thus notify the examiner of the need for follow-up with a more qualified specialist. In this way, the use of AI, together with deep learning and telemedicine, can represent an effective long-term solution for screening and monitoring patients in primary health care,” he concludes.
About the Eyer
Eyer Portable Fundus Camera
The Eyer is a portable fundus camera that works in conjunction with a smartphone and performs high-quality retinal examinations in a few minutes without the need for pupil dilation.
The technology supports the diagnosis of more than 50 diseases, including glaucoma, cataracts, diabetic retinopathy, AMD, retinoblastoma, hypertensive retinopathy and ocular toxoplasmosis. Currently, more than 10 million tests have been carried out in Brazil, the United States, Chile and Colombia.
The technology’s portability and affordability democratize access to retinal examinations. It costs approximately six times less than a conventional tabletop fundus camera, which still needs to be integrated with a computer.
About Phelcom
Phelcom Technologies is a Brazilian medtech company based in São Carlos, in the interior area of São Paulo. The company’s story began in 2016, when three young researchers – a physicist, an electronics engineer and a computer engineer (physics, electronics, computing) – created a portable fundus camera integrated with a smartphone.
The idea for the first prototype was realized by Diego Lencione’s interest in visual health, as his brother has had a condition that has severely compromised his retina and vision since childhood.
In 2019, Phelcom launched its first product on the Brazilian market: the Eyer portable fundus camera. Today, the technology has reached more than two million people across Brazil and worldwide.
In four years, the company has participated in more than 100 social actions and was recently named one of the 10 most innovative companies in Brazil by Forbes.
Augmented reality in health allows a real-time combination of images never before achieved, with new possibilities to diagnose diseases, which can increase accuracy in surgical procedures. That is, it can potentially improve patient quality of life.
In real time, the technology shows the material world overlayed with computer-made images, enabling greatly improved composite observations.
For this, smartphone cameras, tablets, smart glasses and even state-of-the-art helmets are used, so that the hands are unnecessary to command interfaces in systems and applications.
For instance, there is a strong trend to use Augmented Reality (AR) in this industry, according to the Journal of Med Internet Research (JMIR). Even with a still low use by doctors and institutions, there is an increasing number of applications of AR in medicine.
Learn about the advantages of using augmented reality in health and some cases of success.
Augmented reality X Virtual Reality
First, it’s important to understand the difference between augmented reality and Virtual Reality (VR).
AR, in its turn, integrates the physical and the virtual by overlaying computerized images in the real world, through software and devices. For example, the Google Glass app can be accessed from the user’s own mobile phone or tablet. There is also the famous game Pokémon Go, in which players searched for virtual Pokémon in real-world environments using the mobile phone camera.
Augmented reality in healthcare: advantages
Undoubtedly, there are numerous advantages of using AR in health. One of them is to ease access to the patient’s medical history in emergencies or on the surgery table, for example. Image overlaying may also more accurately ensure to locate an area of interest in surgical procedures, thus decreasing risk to the patient. In this case, it is possible to integrate imaging examinations and better see every detail of the organs in the preoperative care and, thus, have more success in surgery.
In fact, technology is a great ally of telemedicine. For example, specialists can instruct other doctors remotely in more complex operations. Another aspect is diagnostic medicine, because the patient can better understand the diagnosis and the recommended treatment.
AR has also been used in the digital screening of patients who have suffered accidents. In these cases, orthopedists help in the performance of arthroscopic surgeries on shoulders and in training interns and residents to carry out ultrasound examination at the care site.
Neurosurgery is one of the most advanced specialties in the use of AR, with reports of tumor resection, open neuro-vascular surgeries, spinal procedures, location of catheters or probes, cortical resection in epilepsy and aneurysms involving unusual trajectories or hidden ramifications.
In hospitals and clinics, the technology assists remote support by enabling on-site technicians and teams to receive specialized help needed for installation, setup, maintenance, troubleshooting, and repair of sensitive and specialized hospital equipment.
Teaching in medicine
Augmented Reality in healthcare allows seeing details of the human body and training procedures in a repetitive and precise way.
Student, imagine practicing surgery in a virtual environment? Stanford University has a simulator which allows the most complete training for the future surgeon.
For researchers, a three-dimensional virtual surgical environment can allow for enhanced preoperative planning and testing. It thus improves patient results, decreases complication rates and improves technical skills.
The Stanford Virtual Surgical Environment (VSE) is developed for rhinologic procedures. The technology allows the surgeon to interact with patient-specific three-dimensional reconstructions of nasal sinus CT data sets using a modified haptic interface device, triggering a virtual endoscope.
In Brazil, there are also options for simulators. For example, Eyesi is aimed at training intraocular cataract surgery and vitreo-retinal procedures. It presents performance score and evaluates tremor, movement accuracy and repetitiveness, among other analyzes. Thus, it is a good tool for resident practice to introduce new techniques in ophthalmic surgery.
There are also the da Vinci surgical systems for robotic surgery, already in the fourth generation. The technology carries out minimally invasive surgeries in different procedures. One of its tools is a console – inspired by flight simulators – in which doctors visualize the high-definition 3D images and make the operative movements with their own hands, which are transmitted to the robot.
Another application is training and retraining for students, residents and specialists in care or in the surgical center. Thus, it is possible to carry out an ethnographic analysis of the performance of the professional, who is alone during the procedure, through the capture of images by a camera installed on the site.
Augmented Reality solutions in healthcare
On the market, there are already quite interesting solutions of AR.
For example, the application EyeDecide allows you to see the eyeball from any angle just by directly touching the image generated on the tablet and rotating it with your finger. It is also possible to reduce, expand, move or make notes on the eye in almost any direction. All this assists to simulate various disorders and helps to diagnose more accurately.
The app Anatomy 4D makes it possible to explore more than two thousand anatomical structures. Undoubtedly, it helps students and medical colleges.
Even with all the advantages, augmented reality in health is still relatively new and is not heavily employed in the area. However, as it proves its value for the quality of patient care, soon AR technologies will be stronger in the medical industry.
Reviewed by Paulo Schor, ophthalmologist, associate professor and director of innovation of the Federal University of São Paulo (Unifesp) and collaborator of the Faculty of Medicine of the Albert Einstein Hospital.
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Everyone already knows that cigarettes are bad for health. This includes the eyes. For example, smoke is a risk factor for various diseases such as dry eye syndrome, glaucoma, cataract, and age-related macular degeneration (AMD).
Learn more about the work that correlated cigarette and eyes, its results and next steps.
Cigarettes and eyes – the research
Scientists at Gifu Pharmaceutical University, in Japan, created cultures of cells from the epithelium of the human cornea and exposed part of them to an extract of cigarette smoke and PTA aerosol, which contained most of the ingredients inhaled by smokers.
After 24 hours, the number of dead cells in cultures exposed to smoke and aerosols was higher than compared to those that did not interact with the substances. Upon contact with cigarette components, the ferritin inside eye cells decomposes, releasing the stored iron.
Results
Exposure to the components of cigarette smoke accumulates iron, which kills cornea epithelium cells. The same reaction was observed with the aerosol produced by heated tobacco products (PTA). Although different from electronic cigarettes, these also require an electronic device for use and do not always come with nicotine.
Generally, cigarette smoke does not cause permanent problems. However, continuous exposure can cause corneal injury such as leukoma and even lead to blindness.
Despite the important results of the study on cigarettes and eyes, more research is still needed, especially in humans, to confirm the findings.
Information from Einstein Agency.
Reviewed by Paulo Schor, ophthalmologist, associate professor and director of innovation of the Federal University of São Paulo (Unifesp) and collaborator of the Faculty of Medicine of the Albert Einstein Hospital.
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Retinal neurons were first identified more than 100 years ago. But now scientists at the University of Utah in the United States have discovered a new type of retinal cell.
Published in the Proceedings of National Academy of Sciences, United States, the research found a hitherto unknown type of interneuron in the retina of mammals.
Learn more about the study, how it was conducted, and the next steps.
The research
In the central nervous system, a complex circuit of neurons communicates with each other to transmit sensory and motor information. “Interneurons” act as intermediaries in the communication chain.
Researchers at John A. Moran Eye Center of the University of Utah (USA) have identified a new type of interneuron in the mammalian retina. The new cell does not fit into the current five classes of retinal neurons: photoreceptors, horizontal cells, bipolar cells, amacrine cells and endogenous cells. This is due to differences presented in their morphology, physiology and genetic properties.
Thus, the scientists responsible for the discovery propose that this new type of cell should belong to a new class of retinal neurons.
The team dubbed the discovery a “bell cell” because of the hand-bell-like shape. The discovery unites two cell types, cones and rods, and does extra processing in the cells. Thus, they relay visual signals of both types of photoreceptor rods and photoreceptor cones in the retina, but their precise purpose is subject of ongoing research.
Experiments have shown that bell cells remain activated for an unusually long time – up to 30 seconds – in response to a 10-millisecond flashlight stimulus.
“In the brain, persistent firing cells are believed to be involved in memory and learning. Once campana cells have a similar behavior, we theorize that they could play a role in requesting a temporal ‘memory’ of a recent stimulation,” said research leader Ning Tian.
Undoubtedly, it is a great discovery that contributes directly to the search for a better understanding of the central nervous system, since it detects all classes of neurons and their connections.
Source: Medical Xpress
Reviewed by Paulo Schor, ophthalmologist, associate professor and director of innovation of the Federal University of São Paulo (Unifesp) and collaborator of the Faculty of Medicine of the Albert Einstein Hospital.
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The World Health Organization (WHO) has long warned about the danger of diabetes. The disease grows year by year around the world, and in the past 40 years the number of cases has quadrupled.
According to the 10th edition of the Diabetes Atlas, published by the International Diabetes Federation (IDF) and recently released, 537 million people aged 20 to 79 have diabetes worldwide. A growth of 16% compared to 2019.
This equals one diabetic out of ten people. The scenario gets even worse: almost half (44.7%) do not even imagine that they face the disease. The projection for next years are 643 million diabetics in 2030 and 784 million in 2045.
Lifestyle, lack of access to healthcare in developing countries and the present pandemics – which increased sedentary lifestyles, poor diets and postponed medical care – are the main factors for these numbers. Learn more about preliminary data IDF presented.
Diabetes around the world
According to the survey, done every two years, 10.5% of the world’s population have diabetes. Thus, the number proportionally exceeds the global population growth. Until then, one person out of 11 was diabetic.
More than that, 44.7% don’t even know they are sick. That can greatly aggravate diabetes, since people only seek help when symptoms arise. Undoubtedly, figures are worrying. Lack of control can lead to other serious problems, such as blindness, kidney damage, changes in the heart and even death.
The disease is also one of the most deadly: 6.7 million people have lost their lives due to diabetes. That is, every five seconds a person dies from this condition. This account does not yet include deaths resulting from complications of other diseases that have been aggravated due to diabetes, such as covid-19.
The presence of the disease is much higher in developing countries: 81% of sick adults live in these localities. That is, 4 out of 5 diabetics. According to atlas, 32 million diabetics are from Latin America and Central America.
So many sick people cost a lot of money: USD 966 billion were spent worldwide with healthcare, a rise of 316% in the last 15 years, according to IDF.
Diabetes in Brazil
In the 2019 edition, there were 16.8 million diabetics in Brazil. In the world ranking, we are in 5th place behind only China, India, the United States and Pakistan.
Among Brazilian Capitals, Rio de Janeiro stands out with the highest rate of diagnoses in the country: 11.2%. Then there is Maceió (11%) and Porto Alegre (10%). The disease also affects more women (9%) than men (7.3%) here.
Data are from the research “Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico” (Vigitel), 2020, a telephone survey research of the Ministry of Health.
With regards to the costs invested in the treatment of Brazilian diabetics aged 20 to 79, Atlas estimates USD 52.3 billion per year. This equals to USD 3 thousand per adult.
More data on Brazil should be published in the full edition, with a release preview for December 6.
Causes
Experts claim that diabetes is increasingly out of control and that there is a lack of information and awareness for prevention. Current lifestyle is one of the main factors for the increasingly high number of the disease cases. Sedentary lifestyle and poor diets, rich in fats and carbohydrates, have brought problems such as hypercholesterolemia, hypertension, overweight, obesity and pre-diabetes, among others.
In low-and middle-income countries, which have the largest number of diabetics, there is a lack of access to healthcare, delaying diagnoses, treatments and even guidance for a balanced diet.
Diabetes and the eye
One of the possible complications of diabetes is in the eyes. According to a study by the Brazilian Society of Ophthalmology (SBO), 40% of people who suffer from diabetes present ophthalmic changes.
Diabetic retinopathy figures among them. Currently, about 40% of the 4 million Brazilians diagnosed with retinopathy have diabetes. In fact, the duration of diabetes and the uncontrolled blood glucose have a direct relationship with retinopathy.
Source: Infographic on diabetic retinopathy – Saúde magazine
This disease subdivides into two types: pre-proliferative, which does not require laser treatment, and proliferative, in which neovases occur and also demand therapy.
For the diagnosis of the correct type, one must evaluate the fundus with examinations.
The disease can also cause glaucoma. The Ministry of Health estimates that people with diabetes are 40% more likely to develop the problem.
In addition, diabetics are 60% more likely to have cataract earlier. In this situation, the problem appears earlier and progresses faster than senile cataracts. Therefore, it is the main cause of vision loss in diabetic patients. However, it is reversible through surgery.
Comparison between a healthy eye and one with cataracts.
It is surely essential for diabetics to be attentive to any changes in their vision. Therefore, even if everything is fine, it is important to undergo periodic examinations with an ophthalmologist.
Prevention and early diagnosis are the keys to avoid serious damage, such as severe visual impairment and even blindness, in case of complications from diabetes.
Reviewed by Paulo Schor, ophthalmologist, associate professor and director of innovation of the Federal University of São Paulo (Unifesp) and collaborator of the Faculty of Medicine of the Albert Einstein Hospital.
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