A research carried out in two referral centers for covid-19 in Rio de Janeiro (RJ) identified alteration in the retina of patients hospitalized in serious condition. The study occurred in May 2020, in the clinical hospitals Mario Lioni and from Jacarepaguá, and was published in the journalPlos One in December, the same year.
The work was also one of the first to discover retinal damage in critical cases of the disease.It is noteworthy that other Brazilian studies, from the ABC School of Medicine (FAMBC) and the Federal University of São Paulo (Unifesp) , published shortly before, also detected retinal alterations.
Researchers used the smart device Phelcom Eyer to carry out the retinography in 47 eyes of 25 patients. Coupled to a smartphone, the device carries out high-quality fundus exams, in few minutes and without need of pupil dilation.It connects to an online platform, the Eyer Cloud, which allows remote diagnosis and assures safety to data stored in the cloud.
“Our study showed that, from the patients hospitalized in serious conditions for covid-19 clinical stabilization, 12% presented some finding”, says one of the doctors responsible for the work, Rafael Lani Lozada, ophthalmology resident in Gamboa Hospital (RJ).
A 35-year-old man from the mentioned sample, who had diverse clinical complications during hospitalization, manifested bilateral nerve fiber layer infarctions and micro-hemorrhages in the papillomacular bundle; another man, 56 years old, who needed to undergo full anticoagulation, had a unilateral “flame-shaped” hemorrhage; and a third man, 49 years old and hypertensive, presented discrete and bilateral retinal micro-hemorrhages.
To Lozada, the study shows retinal alterations may occur in severe covid-19 cases.“They were probably secondary to clinical intercurrences or comorbities rather than a direct damage by SARS-CoV-2, since it was not possible to correlate the problem directly to the virus.Thus, the retinal finding may be important and easily accessible markers of therapeutic interventions, as well as sentinels of neurological and systemic diseases during the pandemic”,
The doctor highlights that new studies with more patients are necessaryto establish statistic correlations between covid-19 and retinal lesions.
Phelcom Eyer
Louzada states that Phelcom Eyer was essential to the project, since the study, as a base, evaluated hospitalized patients in isolation, with a highly contagious and little studied virus.“Using a clean easy-to-handle portable device made it possible for us to step further in the search for a better comprehension of this disease, that afflicts humanity”, he observes.
The researcher also highlights other advantages on the equipment: short learning curve, quick image backup and a possible thorough analysis from any computer with internet access.“Not to mention that the fundus exams are very beautiful, with a great resolution and the color photos are automatically duplicated with red-free images”, he analyzes.
Beyond the pandemic
Lozada also highlights that the technical ease of retina evaluation with Eyer opens new horizons to triage exams, not only in the present pandemic context, but also for other ophthalmological diseases. “The possibility to obtain retinographies in a portable, easy and practical way, through an accessible image backup, allowing their remote careful study, is fundamental for advances in ophthalmological researches and better diagnostics”, he finishes.
During the XIX Caipira Congress, in June 2029, in Bauru (SP), the ophthalmologist Flávio Augusto Schiave Germano met the newly released smart device Phelcom Eyer.
Coupled to a smartphone, the device carries out high-quality fundus exams, in few minutes and without need of pupil dilation.It connects to an online platform, enables remote diagnosis and assures safety to data stored in the cloud.
Some months later, the doctor looked for similar devices in the annual congress of the American Academy of Ophthalmology.“But the national equipment, from São Carlos, proved to be superior both in image quality and design.It is lightweight and portable – handling is quick and intuitive, which makes it easy to use in any situation”, states Germano.
In September, 2020, the ophthalmologist acquired the smart device. He currently uses it every day in his office and in the medical residence service in the Center of Excellence in Ophthalmology (CEO), in Bauru (SP).
In the last six months, he carried out more than 1,1 thousand exams, totaling around 5,5 thousand images.As the service of medical residence works with the glaucoma ambulatory, images are mostly from the optic disc and the surrounding fibers and of the visual field.
Phelcom Eyer
Germano highlights two features of the Phelcom Eyer.“it is not necessary to carry out the exam under mydriasis, which gives more safety to patients with narrow-angle glaucoma*, and it is possible to correct the degree of myopia and hyperopia up to 20 D” he highlights.
Other positive aspects evaluated by the doctor are the fast patient registration, fast imaging and the photo resolution. “It is great and, even when exams are sent to report, the image quality remains high”, he states.
The ophthalmologist sees a great cost-effectiveness in the device. “It is an investment that brings various benefits: it helps the academic department of medical residence, patients feel safer with the regular follow-up through the retinographies and the description in medical records turns more consistent and reliable”, he points out.
Eyer Cloud
Phelcom Eyer integrates to Eyer Cloud, an online platform that enables storing and managing the patient exams. All data the equipment captures synchronize with the system automatically, so that they upload to the cloud with complete safety.
“Eyer Cloud is simple, modern and intuitive,” says Germano. Main features include the possibility of gathering information of a single patient from more than one clinic and visualize them in the platform; searching patients by name or exam date; and creating report templates from pre-ready models that the system provides.
In case of no internet access during the exam, images remain stored in the device and are sent to the cloud as soon as a connection is available.
The tool may be accessed in the device itself or via cellphone, tablet or computer.
Slit lamp
Phelcom slit lamp support. Note: This photo was taken before covid-19 pandemic.
About Phelcom slit lamp support, which enables attaching Eyer to a tabletop, Germano says it eases the documentation by providing agility and optimal alignment between the patient face and the fundus camera.
“The device also offers the advantage of not needing to directly touch the eyelids and eyelashes of patients, which guarantees more safety during the pandemic”, he notes.
Phelcom Technologies
Eyer is the first equipment of Phelcom Technologies, startup that unites technology and health, headquartered in São Carlos (SP). It produces portable devices, connected and wearable, aiming to democratize access to healthcare, offering more from less and to more people.
“Phelcom can synthesize what is best in startups: agility in the communication, highly effective in technical support and innovation in favor of patients. Undoubtedly, Eyer is a great investment in a diagnostic toolbox increasingly important to the ophthalmologic practice”, evaluates Germano.
Eyes are an open door.Contaminated tears as a possible source of contagion.Conjuntctivitis.Retina alterations.Glaucoma.
From symptoms as conjunctivitis to possible sequelae as retinopathy and glaucoma, diverse studies and reports point to the relation of the new coronavirus and the eyes.
As it is a new disease, we sill do not know for sure how itreaches this organ.Therefore, nowadays, researches serve mainly as an alert.
Now, a new study identified small nodules in the eyes of patients with severe covid-19. The work of the French Radiology Society (SFR) was published in the scientific journal Radiology.
Know more about the research, results and how data is important to better understand and encourage investigation of the possible sequelae of the new coronavirus to the eyes.
Study
From March to May 2020, researchers submitted 129 severe covid-19 patients, 43 women and 86 men, to brain MRI exams.They aimed to detect possible anomalies in the eyes.
Results
Nine patients presented one or more small nodules in the posterior macular area:
From them, eight had anomalies in both eyes;
Eight were hospitalized in the ICU;
Seven remained prone for an extended time;
Six were obese;
Two had diabetes;
Two suffered from hypertension.
The team could not identify the reason for the nodules to appear.However, they raised some hypotheses:
Virus-caused inflamation;
Poor blood circulation in the ocular veins in patients intubated in the ICU, such as damage and blockage;
Small eye hemorrhages;
Disruption of nerve fibers.
According to scientists, it is the first time there is documentation of this kind of sequelae through MRI.
Next steps
The volunteers remain under monitoring to observe possible changes of the ocular nodules or vision impairment. In addition, new severe patients from the second and third waves are under evaluation.
In fact, the study needs to deepen, in order to prove the formation of nodules in the eyes due to the new coronavirus. However, the study highlights it is important to capture images of the eyes in severe covid-19 cases and follow the patient post-treatment evolution.
Brain MRI, fundoscopy and optical coherence tomography figure as useful exams.
“Our study advocates triage for all patients hospitalized in ICU with severe covid-19. We believe they must receive specific eye protection treatments”, said ina note the main author of the study, Augustin Lecles, associated professor at the University of Paris, and neuroradiologist* of the Department of Neuroradiology of the Adolphe de Rothschild Foundation Hospital in Paris.
Conclusion
In fact, there is still a long way to prove the correlation between coronavirus and the eyes.However, studies are essential to encourage more attention to the eyes of infected patients, by means of exams and monitoring after the cure.
More than that, this research highlights that patients with pre-existing diseases, such as diabetes and hipertension, have a higher risk factor. Therefore, they also must undergo eye investigations.
Learn first-hand information on the main researches about the coronavirus and the eyes. Follow Phelcom’s blog.
Mydriasis is common in ophthalmological exams that require a complete visualization of the eye structure. As the practice allows to evaluate the whole extension of the lens, it helps to diagnose diseases as glaucoma, diabetic retinopathy, AMD and others.
However, pupil dilation also brings some disadvantages to both doctor and patient, even more during the present pandemics. For example: less daily attendances due to the limit of people in waiting rooms, the need for a companion and discomfort to the patient.
That’s why non-mydriatic equipment earns more and more space in offices, clinics and hospitals. They assure high-quality exams, increase productivity and are, consequently, more profitable.
Read below the advantages of offering non-mydriatic exams and the devices that offer them.
Non-mydriatic: adavantages
1) Increase in the number of medical services
Complete pupil dilation requires the patient to remain in the waiting room, so that he or she can undergo the exam. This process takes considerable time. More than that, a companion is requiretd.
This already occupies two seats that could receive other people, for example. In addition, patients in the waiting room must keep adequate distancing, which decreases the full amount of people allowed in the environment.
The non-mydriatic exam eliminates the waiting time of both the eye drops effect and the exam itself, decreases the service length and the need of a companion for the patient.
That is: more schedule and more space in the office, so that you can attend more patients!
2) High-quality exam
Removing mydriasis from some ophthalmological exams does not affect the quality of the result. On the contrary, some non-mydriatic equipments offer even more sharpness in eye fundus images.
They invest in technologies that capture images through the patient’s natural dilation. Including in places with low light.
3) Less use of anesthetic eye drops
Mydriatic exams also reduce the use of anesthetic eye drops in clinics. They reduce costs with this material – made to avoid burning in patients’ eyes – which is more expensive than the non-anesthetic product.
4) Comfortable and quick exams for children
Fundus imaging is rare in children. When necessary, pupil dilation brings discomfort to the little ones. With the farewell to mydriasis, exam speed and well-being increase.
Another interesting possibility for non-mydriatic exams is the early eye-fundus imaging, so that the evolution may be followed throughout adult life.
5) Patient comfort
Non-mydriatic exam is undoubtedly advantageous to the patient: less discomfort with pupil dilation, no need to find available companion and less time in office. The latter advantages are even more relevant with the pandemic.
6) More safety to carry out the exam
In fact it is quite safe for the patient to dilate the pupil for ophthalmological exams. However, reactions as allergy to eye drops, dizziness or malaise may occur in some cases. Graver complications may occur very scarcely such as acute glaucoma crisis, mainly in patients with narrow anterior chamber angle, mainly related to a high degree of myopia (six degrees or higher).
Since possible reactions are not assertively predictable, removing mydriasis from some exams eliminates the risk of complications.
Non-mydriatic – devices
Several non-mydriatic devices are available on the market, from tabletop to portable. Phelcom Eyer smartdevice is one of them.
Phelcom Eyer is the first handheld fundus camera with the quality of a tabletop equipment. Coupled to the smartphone, it carries out high-quality retina exams, without need of pupil dilation and in less than a minute.
Since it is easily operable, even a minimally trained healthcare professional is able to carry out the exam.
The technology includes the Autofocus function, compensating refractive errors from -15D to +20D, allowing high detail retinal scans.. It utilizes the patient’s natural dilation and can capture images even in low light environments.
Another functionality are the panoramic exams with a visual field over 100 degrees, since Eyer has fixation targets that help panoramic capture and imaging.
It is also connected to an online platform, Eyer Cloud, which stores and organizes all the exams in a cloud system.
Learn the main features of this technology:
Type: Non-mydriatic digital fundus camera
Visual field: 45 degrees
Resolution: 12-Mega-Pixel Sensor
Exams: Colour, Red-free and Anterior Segment
Internal fixation targets: 9 fixation targets for peripheral mapping
Focus: -15D to +20D with autofocus
Pupil: Minimum size 3mm
Format: JPEG, PDF and DICOM
Conclusion
Non-mydriatic exams undoubtedly offer various benefits to doctors: quick exams, with more attendances and a more profitable office; high-quality results; cost reduction with anesthetic eye drops; faster exams for children and safer exams.
Follow Phelcom’s blog for main news on technologies in exams.
Algorithm was runned during the Itabuna Diabetes Campaign and helped the health professionals to screen and refer more than 820 Diabetic Retinopathy patients. The solution will be released to the market still in 2021.
Phelcom fundus camera, the Eyer, has been used in Itabuna Diabetes Campaign several times, but this year it was different. In the captured images was runned an Artificial Intelligence algorithm developed by Phelcom, where it could be identified with a good sensitivity and specificity patients with Diabetic Retinopathy (DR) condition.
Exam being performed using the Eyer during the Itabuna Diabetes Campaign.
The sensitivity was 97.8%, what means a high algorithm capacity in identifying patients with DR. When it was analyzed the specificity, the number reached was 61.4%, that indicates the percentage of health patients that the algorithm confirmed that really was healthy. The AUC, Area Under the Curve, was 0.89 and it shows in this scenario a high rate of the algorithm assertivity to refer just DR patients to in person consultation and not the healthy ones.
Sensitivity was high when indicating more than mild cases, the ones where the patient needs to undergo a medical treatment with a specialist – the mild ones are usually monitored at every given time period. Besides specificity was not in a higher score as sensitivity, it was a good result considering the algorithm was not only detecting DR, but other retinal alterations like hypertensive retinopathy, aged macular degeneration (AMD), toxoplasmosis, among others, while the physician was focused on this project to detect just DR cases.
Examples of the algorithm heath map enhancing the colours in regions where it was detected retinal alterations and pointing the percentage of the Retinal Alteration Score. Source: Phelcom.
The article, published in the Journal of Diabetes Science and Technology, points out that screening patients on diabetic retinopathy could be one of the most cost-effective initiatives on diabetes care, but in several scenarios there is insufficient health care structure and resources in terms of funding, trained health care human resources, and facilities.
Eyer is a portable, connected and affordable device to perform posterior and anterior eye exams, these characteristics were highly suited to capture the images during the health campaign. As the equipment offers high quality images, to run an artificial algorithm in the images was a natural step, as it could help the health professionals screen more than 820 patients.
Phelcom has been developing this solution during the past few years, it still has no commercial name, but it will be available on the market still in the first semester of 2021. José Stuchi, CEO at Phelcom, says the company aims to develop new artificial intelligence services that will be aggregated to the EyerCloud, Phelcom’s cloud system to store patients medical records. “We are sure that this new algorithm and other ones we are working on will help physicians to diagnose those challenging conditions that sometimes are difficult to be identified to the unaided eye”, he stands.
When working with scarce resources, whether human, financial or material, Phelcom is creating solutions to break down barriers to eye care access, enabling health professionals to reach patients in different scenarios and regions.
The full publication and results are available in the original article, access: https://journals.sagepub.com/eprint/H58YCATDBNT5YRZYAXKW/full
Undoubtedly, diagnosing Parkinson’s disease is a challenge. Some procedures to identify signs of the disease have high costs, such as computed tomography and magnetic resonance imaging. In addition, millions of people worldwide do not have access to these technologies. According to the World Health Organization (WHO), currently, about 6.3 million suffer from the problem.
Since the first symptoms only manifest with the progression of the disease, early detection is another challenge. A new research from the United States has developed a cheaper way to diagnose the disorder: artificial intelligence applied to the retinal exam. The results were presented at the last annual meeting of the Radiological Society of North America (RSNA).
Learn about the study, how it was done and how the results achieved help to democratize access to healthcare.
Research
Researchers at the University of Florida (USA) used the machine learning principleto create an artificial intelligence tool that learns to detect signs of Parkinson’s disease in retinal examinations. They trained the “support vector machine” with eye fundus images of patients with the disease and control participants without the disorder.
As the problem deteriorates nerve cells and, consequently, thins the retinal walls, a simple fundus examination can already diagnose it. The disease also damages the retinal microvasculature.
Results
The results show that Parkinson’s disease can be diagnosed from changes in the retina. Currently, several studies prove that damage to the brain can be observed through the eyes .
“The most important finding was that a brain disease was diagnosed with a simple eye image. The diagnosis can be made in less than a minute and the equipment costs much lower than a computed tomography or magnetic resonance imaging ”, says Maximillian Diaz, the researcher in charge.
Conclusion
Undoubtedly, by applying machine learning techniques to the artificial intelligence system used in the retinal scan, scientists can diagnose Parkinson’s disease faster, more assertively, cheaply and accessibly.
Early detection, even before the first symptoms, allows the treatment to start as soon as possible and provide the patient more life-quality.
The results of the research can also help in a better understanding of the disease in the search for a cure and in ways to slow the evolution.
In addition, the researchers say the new artificial intelligence tool can be used to identify other diseases that damage the brain, such as Alzheimer’s disease and multiple sclerosis.
Follow the main researches related to the eyes on Phelcom’s blog.
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