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PurposeThis study aims to design an eye model that can simulate the fundus for teaching direct ophthalmoscopy and to evaluate its effectiveness.MethodsWe first used 3D printing materials to make an eye model and then randomly assigned 92 undergraduates into group A (model-assisted training group) and group B (traditional training group) to test our model. After the same training time, real patients were used to test the students, with 120 s as the examination time limit. We recorded the students’ ability to clearly see the optic disk, the time to determine the cup-to-disk ratio, and whether they were correct.ResultsForty-three students in group A (93.48%) successfully saw the fundus, while 21 in group B (45.65%) succeeded. The difference between the two groups was 47.83% (95% confidence interval, 29.59–66.07%, P < 0.0001). The median time to see the fundus was 29s (95% confidence interval 23–45 s) in group A, while an estimated minimum time in group B was 80 s, indicating that group A was significantly faster than group B (P < 0.0001).ConclusionsThis 3D-printed eye model significantly improved the students’ study interest, study efficiency, and study results and is worthy of being promoted.

ObjectivesTo evaluate the use of a three-dimensional heads-up microscope (3DM) during 25-gauge pars plana vitrectomy (PPV) compared with a traditional ophthalmic microscope (TM) in terms of efficacy, safety, and teaching and learning satisfaction.MethodsProspective comparative interventional study. Fifty eyes affected by one of the following diseases: rhegmatogenous or tractional retinal detachment, epiretinal membrane, full-thickness macular hole, vitreous hemorrhage, or dropped lens. The 50 eyes were randomly assigned to one of two groups: group A (25 eyes) underwent 25-gauge PPV with 3DM, and group B (25 eyes) underwent 25-gauge PPV with TM. The main outcome measures were the duration of the operation, intraoperative complications, and surgeon and observer satisfaction. A questionnaire was used to assess surgeon satisfaction according to the following parameters: comfort, visibility, image quality, depth perception, simplicity of use, maneuverability, and teaching. A questionnaire to assess observer satisfaction was completed by 20 observers (surgical residents or ophthalmic surgeons).ResultsThe degree of satisfaction was higher using 3DM for both surgeons and observers (P < 0.001). The average duration of the operation did not differ significantly between the two methods. No major complications occurred for either method.ConclusionsPPV with 3DM is more comfortable for the surgeon and poses no substantially greater risk of complications for the patient. The high-definition screen delivers excellent depth perception and better screen parameter control, which results in high-quality surgical performance. 3DM surgery helps to significantly improve teaching and learning intra-operative surgical procedures.

Background The use of simulators for ophthalmology training is growing globally. However, all developed simulators have certain limits based on different circumstances. The study aims to evaluate training performance and student satisfaction of the new refractive adjustment simulator \"ICEyeModel\" compared with a traditional simulator for direct ophthalmoscopy training among medical students. Methods This constitutes a comparative, randomised, cross-over study. Our study enrolled 50 participants from a 6-year medical student training programme at Phramongkutklao Hospital. They underwent a refresher lecture on primary direct ophthalmoscopy use and a short course review of common retinal diseases. They were randomised into two training sequence groups: Training sequence 1 started with a traditional film photograph simulator called Eye Retinopathy Trainer (developed by Adam, Rouilly Co., Sittingbourne, UK) followed by the ICEyeModel. Training Sequence 2 started with the ICEyeModel, followed by a traditional simulator. Participants in both groups completed the fundoscopic description tests and satisfaction questionnaires immediately following each simulator training session. Results On an 18-point prospective rubrics scale, medical students trained with ICEyeModel achieved significantly higher fundoscopic examination scores (14.42 ± 2.34) compared to those trained with traditional simulators (11.30 ± 2.64), with p  < 0.001. For the ICEyeModel, 86% of the participants can correctly adjust the direct ophthalmoscope power match to the refractive state of the trial lens placed in the simulator. The ICEyeModel has a higher satisfaction score regarding picture quality, enhancing motivation and confidence than a traditional simulator. Conclusion In comparison with the Eye Retinopathy Trainer, the ICEyeModel significantly enhanced performance with increased satisfaction and self-confidence in simulated direct ophthalmoscopy training. Although these improvements were observed in a simulation setting and do not necessarily translate to superior performance in patient examinations, our findings suggest that the ICEyeModel may offer a promising alternative for training with direct ophthalmoscopes, indirect ophthalmoscopes, and retinoscopes in clinical settings.

The current standard of care for retinopathy of prematurity (ROP) screening eye examinations, binocular indirect ophthalmoscopy (BIO), is associated with discomfort and stress in infants. In this study, we compared pain scores and vital signs during examination with BIO and non-contact laser speckle contrast imaging (LSCI). Preterm neonates underwent retinal exam with BIO and LSCI during ROP screening. Infant stress was scored using the Neonatal Pain, Agitation, and Sedation Scale (N-PASS), and collected with vital signs, before, during, and after eye examination. Seventy-one infants with gestational ages 22–32 weeks and birthweights 400–1900 g underwent 196 BIO examinations and 101 LSCI examinations. N-PASS scores during BIO were significantly higher than LSCI (8.8 vs. 3.7, p  < 0.0001). Maximum heart rate was significantly higher during BIO compared to LSCI (182 ± 19 beats per minute vs. 175 ± 20 beats per minute, p  = 0.008). Minimum oxygen saturation was significantly lower during BIO compared to LSCI (83 ± 12% vs. 86 ± 10%, p  = 0.035). After BIO, vital sign instability remained for 30 s, whereas vital signs returned to baseline after LSCI. We found lower pain scores and more stable vital signs during LSCI compared to BIO.

PurposeWe investigated using ultrawide-field fundus images with a deep convolutional neural network (DCNN), which is a machine learning technology, to detect treatment-naïve proliferative diabetic retinopathy (PDR).MethodsWe conducted training with the DCNN using 378 photographic images (132 PDR and 246 non-PDR) and constructed a deep learning model. The area under the curve (AUC), sensitivity, and specificity were examined.ResultThe constructed deep learning model demonstrated a high sensitivity of 94.7% and a high specificity of 97.2%, with an AUC of 0.969.ConclusionOur findings suggested that PDR could be diagnosed using wide-angle camera images and deep learning.

Introduction Non-ophthalmologists often lack sufficient operational training to use a direct ophthalmoscope proficiently, resulting in a global deficit of basic ophthalmological skills among general practitioners. This deficiency hampers the timely diagnosis, referral, and intervention of patients. Consequently, the optimization of teaching tools and methods to enhance teaching efficiency is imperative. This study explores the effectiveness of the Eyesi Direct Ophthalmoscope Simulator (Eyesi) as an innovative tool for fundus examination training. Methods Medical undergraduates were randomly assigned to Group A or B ( n  = 168). All participants completed a pre-training questionnaire. Group A received Eyesi training, while Group B underwent traditional direct ophthalmoscope (TDO) training. Subsequently, participants answered questionnaires relevant to their respective training methods. Both groups exchanged training tools and completed a summary questionnaire. Results After training, 54.17% of participants believed that images presented by the Eyesi were consistent with the real fundus. Group A scored significantly higher than Group B in fundus structure recognition and self-confidence in examination. The degree of mastery over fundus theory score increased from 6.10 ± 0.13 to 7.74 ± 0.16 ( P  < 0.001) in Group A, but Group B did not demonstrate a significant difference. We also compared undergraduates’ tendencies for different learning purposes, 75.59% of participants preferred the Eyesi to TDO as a training tool, and 88.41% of participants were receptive to introducing the Eyesi in training. Conclusion According to subjective participant feedback, Eyesi outperformed TDO in fundus observation, operational practice, and theoretical learning. It effectively equips undergraduates with fundus examination skills, potentially promoting the use of direct ophthalmoscopes in primary medical institutions.

PurposeTo investigate whether the observed international differences in retinopathy of prematurity (ROP) treatment rates within the Benefits of Oxygen Saturation Targeting (BOOST) II trials might have been caused by international variation in ROP disease grading.MethodsGroups of BOOST II trial ophthalmologists in UK, Australia, and New Zealand (ANZ), and an international reference group (INT) used a web based system to grade a selection of RetCam images of ROP acquired during the BOOST II UK trial. Rates of decisions to treat, plus disease grading, ROP stage grading, ROP zone grading, inter-observer variation within groups and intra-observer variation within groups were measured.ResultsForty-two eye examinations were graded. UK ophthalmologists diagnosed treat-requiring ROP more frequently than ANZ ophthalmologists, 13.9 (3.49) compared to 9.4 (4.46) eye examinations, P=0.038. UK ophthalmologists diagnosed plus disease more frequently than ANZ ophthalmologists, 14.1 (6.23) compared to 8.5 (3.24) eye examinations, P=0.021. ANZ ophthalmologists diagnosed stage 2 ROP more frequently than UK ophthalmologists, 20.2 (5.8) compared to 12.7 (7.1) eye examinations, P=0.026. There were no other significant differences in the grading of ROP stage or zone. Inter-observer variation was higher within the UK group than within the ANZ group. Intra-observer variation was low in both groups.ConclusionsWe have found evidence of international variation in the diagnosis of treatment-requiring ROP. Improved standardisation of the diagnosis of treatment-requiring ROP is required. Measures might include improved training in the grading of ROP, using an international approach, and further development of ROP image analysis software.

To investigate the utility of smartphone ophthalmology for medical students for learning fundoscopy compared with direct ophthalmoscopy. After 1 hour of didactic instruction on ophthalmoscopy, second-year medical students in a small group setting were randomized to start training with the direct ophthalmoscope vs smartphone ophthalmoscope and crossed over to the other instrument through the session. Ability to visualize the optic nerve and retinal blood vessels in an undilated pupil as well as a survey evaluating ease of use, confidence, and ability to visualize the optic nerve with the two instruments. One hundred and one medical students participated. Significantly more medical students were able to visualize the optic nerve with the smartphone ophthalmoscope vs the direct ophthalmoscope in an undilated pupil (82.3% vs 48.5%, <0.0001). Students reported a more positive experience with the smartphone ophthalmoscope, specifically regarding ease of use (median of 4 vs 3; <0.0001), their confidence in performing ophthalmoscopy (median of 4 vs 3; <0.0001), and their ability to visualize features of the optic nerve (median 4 vs 3; <0.0001). A significant number of participants preferred the smartphone ophthalmoscope over the traditional direct ophthalmoscope for learning how to identify the optic disc and for evaluating patients (78.2% and 77.2%, respectively; <0.0001). Smartphone ophthalmoscopy may serve as a useful adjunctive tool to teach direct ophthalmoscopy as well as being an alternative for examining the fundus for noneye care physicians.

A deep-learning system that was applied to 14,341 fundus photographs differentiated optic disks with papilledema from normal disks with 96.4% sensitivity and 84.7% specificity in an external-testing data set. The prevalence of papilledema was 9.5%, yielding positive and negative predictive values of 39.8% and 99.6%, respectively.

Background To analyse reticular pseudodrusen (RPD) in patients with age-related macular degeneration (AMD) using multi-spectral (MS), confocal scanning laser ophthalmoscopy (cSLO). Methods cSLO images (blue fundus autofluorescence [FAF; exc., λ = 488; em., λ = 500–700 nm], near-infrared reflectance [IR; λ = 820 nm], MS [blue reflectance (BR) λ = 488 nm, green reflectance (GR) λ = 515 nm, IR λ = 820 nm], as well as colour fundus photographs (CFP) were taken of 200 eyes from 100 AMD patients suspected to show RPD on the basis of funduscopy or previous fundus imaging. FAF and IR images were graded by two independent readers. If both readers concordantly confirmed the presence of RPD in both modalities, eyes were subsequently also graded for RPD in MS, BR, GR, green-blue enhanced mode (GBE), and CFP. Besides, FAF, IR, and MS images were evaluated for the presence of a target aspect, which represents a common feature of RPD lesions. Results The presence of RPD was confirmed using FAF and IR images by both readers in 130 eyes of 76 patients. In those eyes, both readers concordantly diagnosed RPD in MS images in 124 (95.4 %) eyes (BR: 52 [40.0 %], GR: 63 [48.5 %], GBE: 101 [77.7 %], CF: 27 [20.8 %]). Cohen kappa statistics revealed excellent inter-observer agreement for MS (0.95) and GBE (0.85), substantial agreement for BR (0.75), GR (0.78), and moderate agreement for CFP (0.59). A target aspect within RPD lesions was detected in 45 of 130 (35.0 %) included eyes using FAF and IR. The presence of a target aspect improved the recognition of RPD lesions in all modalities. If a target aspect was present, RPD were diagnosed in 45 eyes (100 %) using MS (GBE: 42 eyes [93.3 %], BR: 30 eyes [66.7 %], GR: 37 eyes [82.2 %], CFP: 17 eyes [37.8 %]). Using MS cSLO, a target aspect could be identified in 75 of 130 (57.7 %) included eyes. Conclusions MS cSLO imaging is equivalent to FAF and IR in identifying RPD in AMD patients. Higher identification rates in BR and GR of those RPD lesions featuring a target aspect confirm the current hypothesis of RPD localisation and its progression further into the photoreceptor layers. MS seems to be more sensitive in identifying a central target aspect in RPD lesions compared to blue FAF and IR.