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PubMedDate not supplied

Use of keratoscopy, slit-lamp biomicroscopy, and retinoscopy in the management of astigmatism after penetrating keratoplasty.

Selective suture removal following corneal transplant surgery can facilitate the reduction of astigmatism. We present concepts concerning astigmatism analysis after keratoplasty related to suture compression by reviewing keratoscopy, slit-lamp biomicroscopy, and retinoscopy findings. Keratoscopy observations indicating tight sutures include peripheral indentation of the keratoscope rings, individual keratoscope ring images between tight sutures, and decentration of the corneal apex away from a tight suture. The utilization of the Van Loenen keratoscope at the slit-lamp in "dynamic keratoscopy" allows the surgeon to readily recognize these findings and also proves useful intraoperatively. Slit-lamp biomicroscope observations indicative of tight sutures include a doughnut of tissue compression, Kaye's epithelial white dots, and epithelial or endothelial stress lines. Retinoscopy observations demonstrate that tight sutures induce astigmatism with the narrowest side of the retinoscopy beam pointing directly toward the tightest suture. Astigmatism management plays a major role in the future success of ophthalmology and needs to be increasingly integrated into the practice of the general ophthalmologist.

Aged↗
PubMed1978

Studies on retinal blood flow. I. Estimation of human retinal blood flow by slit-lamp fluorophotometry.

This article describes a new direct method for estimation of human retinal blood flow by slit-lamp fluorophotometry. The apparatus consists fundamentally of a modified slit lamp with an eye piece containing two fiberoptic probes connected to a double photometric detection system. Both optic fibers are focused on a retinal arterial segment, and the passage of a fluorescein bolus is automatically registered, giving, after correction, the mean transit time. Fluorescein angiography allows the determination of the volume of the arterial segment under study. Values for superior temporal retinal blood flow in healthy individuals show a mean value of 4.2 +/- 0.5 microliter/min. Studies in anemic patients show an increase of approximately 52% in the retinal blood flow. The potential causes of error associated with this technique, apart from the slight increase in intraocular pressure induced by the contact lens used, do not appear to be significant.

Adolescent↗
PubMed1986

Modifications of the slit lamp for digital image processing of the anterior segment of the eye.

The Zeiss slit lamp has been modified in order to extend its use to measurements of lens transparency. Two major modifications have been introduced: (1) a support for a high-sensitivity TV camera that is connected to an image processing system; (2) two potentiometers for recording electrical signals proportional to the rotation angle of the slit-supporting arm with respect to the visual axis and the slit tilting angle. As a result, the slit lamp output consists of three signals; one TV signal for the images and two analog signals for measurement of the angles. With the aid of an image-processing system connected to a minicomputer, software has been developed to enable the operator to acquire reliable digital images of the anterior segment of the eye in real time. The software provides the user with an easy-to-follow menu.

Anterior Eye Segment↗
PubMed1979

Slit-lamp attachment for examination of donor corneas in McCarey-Kaufman medium.

An attachment permits slit-lamp examination of excised donor cornea in McCarey-Kaufman medium. The bottle that contains the excised cornea is placed in a holder and examined with the slit lamp by means of a mirror placed at a 45 degree angle. This mirror reflects the slit beam up through the bottom of the bottle. This allows accurate examination of the donor cornea in a stable manner that was not previously possible.

Corneal Transplantation↗
PubMed1989

Non-stereo photographic screening after panretinal photocoagulation for proliferative diabetic retinopathy. Compared with 60D enhanced slit-lamp examination.

135 patients treated with panretinal photocoagulation for proliferative diabetic retinopathy were examined in order to detect 7 specific fibrovascular lesions after treatment. Two presumptive methods for long-term follow-up were evaluated and compared, i.e. slit-lamp biomicroscopy enhanced by a 60 D lens and reading from two non-stereo photographs of the posterior pole. Two observers repeated their examinations with respective methods. Comparison of the methods with respect to detecting ability of the fibrovascular lesions showed no significant disagreement except in some eyes with fibrous tissue on the optic disc where new vessels were better detected with the slit-lamp method (P less than 0.001). There was no difference between the methods with respect to the intra- and inter-observer variability. Twenty to 30 patients could be diagnosed per hour with the photographic method compared to 5-6 patients with the slit-lamp. Two non-stereo photographs of the posterior pole can be recommended as a safe and time-saving method for objective documentation and long-time follow-up after panretinal photocoagulation for proliferative diabetic retinopathy.

Adult↗
PubMed1995

Relationship between spectral transmittance and slit lamp color of human lenses.

PURPOSE: To study the relationship between subjective lens color as observed with slit lamp biomicroscopy and spectral transmittance of the lens. To propose a model for this relationship to derive quantitative information on lens pigmentation from slit lamp observation. METHODS: Twenty-nine normal lenses, from donors aged 14 to 86 years, were used. The fraction of light transmitted from a narrow beam was measured as function of wavelength. The spectra were fitted with the one-parameter TL model of Pokorny et al. The relationship between this parameter and the color grading from Chylack et al. (lens opacity classification system III nuclear color score) was established. RESULTS: After slight adaptation of the TL model, the shapes of the transmittance spectra corresponded closely to the TL model (average residual error 0.05 log units). Log transmittance and lens opacity classification system nuclear color score were closely related (r = 0.90, 0.77, and 0.55 for 400, 500, and 602 nm, respectively). CONCLUSIONS: A mathematical relationship between TL parameter and lens opacity classification system nuclear color score could be established to predict lens transmittance from lens opacity classification system nuclear color score. This relationship was successful in predicting the correction for lens absorption needed in blue-on-yellow perimetry.

Absorption↗
PubMed2002

Evaluation of a district-wide screening programme for diabetic retinopathy utilizing trained optometrists using slit-lamp and Volk lenses.

BACKGROUND: Debate exists about the optimum way to screen for diabetic retinopathy. Cameras produce a permanent record, but offer patients less choice about when and where to be screened. Optometrists offer flexibility but sensitivity and specificity of schemes have varied considerably, perhaps because of variability in screening methodology and that there is frequently no quality assurance programme. AIMS: To audit our district-wide (population 340000) screening programme for diabetic retinopathy against national targets: sensitivity > 80%, specificity > 95% and referral to review < 3 months. METHODS: Trained optometrists performed slit-lamp examination with Volk lenses (78 dioptre) with standardized reporting. Audit was by ophthalmologist with slit-lamp and Volk lenses through dilated pupils. RESULTS: We examined 872 eyes of 439 patients; 64% were normal, 29% background diabetic retinopathy, 7% sight-threatening eye disease (STED). Sixty-three percent of patients were seen within 6 months of the original screen. Of these, sensitivity for any retinopathy was 72%, specificity 77%, positive predictive value (PPV) 53%, negative predictive value (NPV) 88%. For STED, in this group, sensitivity was 87% and specificity 91%, PPV 30%, NPV 99%. Median interval referral to ophthalmological review was 11.5 weeks with 73% reviewed in under the 13-week target. Of those referred 25% received laser therapy. Eleven patients found to have referable eye disease at their initial screen were not referred to an ophthalmologist by their GP. CONCLUSIONS: We conclude that effective district-wide screening for diabetic retinopathy by optometrists using slit-lamp and Volk lenses is possible; however, only 36% of identified people with diabetes in the district were screened over a 4-year period.

Diabetic Retinopathy↗
PubMedDate not supplied

Screening for diabetic eye disease by optometrists using slit lamps.

Diabetic patients were screened for diabetic eye disease by hospital-based optometrists using a slit lamp with a 78-dioptres Volk lens. Visual acuity and intraocular pressure were also measured. Of 622 patients screened, 149 (24.0%) had background and 32 (5.1%) advanced retinopathy/maculopathy. The fundus was inadequately visualised in four (0.6%) patients. Following screening, 86 (13.8%) patients were referred to the ophthalmology clinic for appropriate treatment and follow up. Hospital-based optometrists using a slit lamp offer a useful new method for screening for diabetic eye disease. They can identify previously unrecognised sight-threatening diabetic eye disease and important non-diabetic eye disease requiring intervention, and are relatively cheap. This method is ideally suited for rapid referral to the specialist. The results merit larger-scale studies both to confirm the effectiveness of this method and to assess whether hospital trained optometrists could perform screening in the community.

Adult↗
PubMed2002

[Research on slit lamp bio-microscope image analysis system].

Slit lamp bio-microscope image analysis system can provide objective and quantitative diagnosis evidences for ophthalmologists and make available efficient storing, management and intercourse of sufferer information and diagnosis results. In this paper, the system is discussed on its devices, software structure, analysis process and algorithm.

Algorithms↗
PubMed2001

Effectiveness of optometrist screening for diabetic retinopathy using slit-lamp biomicroscopy.

PURPOSE: To assess the effectiveness of optometrists as screeners for diabetic retinopathy using slit-lamp binocular indirect ophthalmoscopy through dilated pupils. METHODS: Prospective study of a screening scheme. Screening was performed by 27 locally accredited optometrists in their practice. The referral protocol used a new simple grading system of retinopathy, especially designed for use in an optometrist screening programme. All positive referrals and 10% of negative referrals were reexamined by an ophthalmologist. Sensitivity, specificity, likelihood ratios and technical failure rates were calculated. RESULTS: The optometrists screened 4904 people with diabetes in 18 months. 'Subthreshold' (screen negative) reports accounted for 4438 (90.5% of 4904); 429 (9.67%) of these were re-examined at secondary screening. There was disagreement regarding grading in 13 patients, of whom 5 (1.16% of 429) had sight-threatening retinopathy (STDR); this extrapolates to 52 patients if all the 4438 test-negatives had been examined. Of the 371 'threshold' patients, 112 (30.18%) were false positives; the commonest cause for false positive referral was drusen in patients with background diabetic retinopathy. The sensitivity for identification of STDR was 76% (95% CI 70% to 81%) and specificity 95% (95% CI 95% to 96%). The likelihood ratio of a positive test indicating STDR was 16.54 (95% CI 14.17 to 19.23) and that of a negative test 0.25 (95% CI 0.20 to 0.32). The technical failure rate was 0.2%. CONCLUSIONS: Suitably trained and accredited community optometrists performed well when screening for diabetic retinopathy using slit-lamp biomicroscopy through a dilated pupil. This was facilitated by the use of simple grading and referral criteria. The sensitivity, positive likelihood ratio and specificity were high.

Accreditation↗
PubMed1989

Non-stereo fundus photography as a screening procedure for diabetic retinopathy among patients with type II diabetes. Compared with 60D enhanced slit-lamp examination.

The spectrum of diabetic retinopathy, the need for fundus screening and the evaluation of two presumptive screening methods, was investigated in a population based study among patients with type II diabetes. Retinal evaluation was performed in 86.9% of the known diabetic population. Background diabetic retinopathy was detected in 37.8%, pre-proliferative in 1.1% and proliferative retinopathy in 3.8%. Diabetic maculopathy was found in 24.3% of the patients. Laser therapy was considered in 11.4% of the patients due to diabetic retinopathy, and in 14.6% when venous occlusive diseases were included. Two methods, a slit-lamp observation enhanced by a 60D lens and reading from two non-stereo photographs of the posterior pole, were evaluated among 154 patients willing and mentally capable of being examined by either method. The sensitivity of the photographic method was 87/97% (right eye/left eye) when detecting background retinopathy and 81/80% for maculopathy versus 69/61% and 79/63%, respectively, with the slit-lamp method. The photographic method could be applied in 93% of the patients mentally capable of cooperation. Only 5 or 6 patients could be examined per hour with the 60D slit-lamp compared with 30-35 examined by reading retinal photographs. The photographic method is recommended as an easy and reliable screening device for diabetic retinopathy among patients with type II diabetes.

Adult↗
PubMed1978

Slit-lamp beamsplitter for two stereoscopic views.

A double binocular beamsplitter, compatible with Zeiss optics, splits the light from each optical train of a slip-lamp microscope to provide an observer the exact stereoscopic view of the examiner. It has advantages in teaching slit-lamp examination techniques. Further, in surgery at the slit lamp, it allows the observer to function as an assistant and the surgeon to have both hands free.

Eye Diseases↗
PubMedDate not supplied

Enhanced documentation of slit-lamp images of the human vitreous stained with fluorescein sodium.

BACKGROUND AND OBJECTIVE: To develop a new method to document the slit-lamp image of the vitreous body as stained with fluorescein sodium. PATIENTS AND METHODS: The system consists of a Goldmann-type slit-lamp biomicroscope, a highly sensitive monochromatic charge-coupled device camera, and a video attachment for real-time observation and recording. As a standard procedure, observation of the vitreous was conducted 60 minutes after intravenous administration of 500 mg of fluorescein sodium. This method was applied to 19 eyes with various eye diseases. RESULTS: Fine details of the vitreous were observed in all of the eyes. Posterior vitreous detachment could be recorded in 5 of the 19 eyes examined. Vitreoschisis and large lacunae were documented in 11 eyes. CONCLUSION: This method promises to be of value in detecting early age-related and pathological changes of the vitreous such as posterior vitreous detachment and vitreoschisis in clinics.

Adult↗
PubMed1988

Slit-lamp photography made easy by a spot metering system.

The use of a standard 35 mm camera with a spot metering system to take slit-lamp photographs is described. This system is mounted on a standard Haag-Streit slit-lamp and can be used with good results even by inexperienced operators.

Eye Diseases↗
PubMed1977

[The slit-lamp as operating microscope a personal device (author's transl)].

Instead of the operating doublemicroscope described by Harms the Zeiss slit-lamp was suspended on the microscope stand by means of two special couplings in form of two stairs, so that the biomicroscopy in the optic section can be performed also when operating, especially in surgery of the retina when using contact glasses. This improvisation is a cost saving alternative against the newly commercially available operating slit-lamp.

Humans↗
PubMed1995

Clinical evaluation of corneal epithelial barrier function with the slit-lamp fluorophotometer.

We designed a simple and quantitative method for the clinical evaluation of corneal epithelial barrier function using a slit-lamp fluorophotometer and applied it to healthy volunteers and dry-eye patients. The fluorophotometric method used was as follows: Three microliter of 0.5% fluorescein solution was applied to the cornea in the untouched fashion. Ten minutes after instillation, the ocular surface was washed. Twenty minutes afterward, corneal fluorescence intensity was measured and converted into fluorescein concentration. Corneal condition was classified into four grades: no superficial punctate keratopathy (SPK) anywhere on the cornea (grade 0); no SPK at the central cornea (grade 1), mild SPK at the central cornea (grade 2), and severe SPK at the central cornea (grade 3). In the volunteers, corneal condition was classified as grade 0 and fluorescein uptake (ng/ml) was 22.4 +/- 16.9 (mean +/- SD, n = 86). In dry eye, fluorescein uptakes showed significant increase in accordance with SPK severity: grade 1: 96.4 +/- 51.2 (n = 13); grade 2: 318.6 +/- 146.0 (n = 11); and grade 3: 1479.1 +/- 671.9 (n = 10) (each p < 0.0005). This simple method with the slit-lamp fluorophotometer can be used for the clinical grading of SPK in dry eye or other ocular surface diseases.

Adolescent↗
PubMed1986

Slit-lamp measurement of the anterior chamber depth.

A technique is proposed which allows assessment of the anterior chamber depth with a standard table slit-lamp without any extra attachments. A final approximation is made which suggests that a 1 degree change in the angle between the observation and illumination systems of the slit lamp when the end point is reached indicates a change in anterior chamber depth of 0.1 mm.

Adult↗