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PubMed1977

Mydriatic angle-closure glaucoma--mechanism, evaluation and reversal.

Ocular mydriatics are diagnostic agents that generally facilitate a preferable ophthalmoscopic examination. However, the optometrist should be aware of certain iatrogenic side effects including the precipitation of an acute angle-closure. The purpose of this paper is to summarize the mechanism of mydriatic angle-closure glaucoma. In addition, a shallow anterior chamber is a fundamental ocular variable which should be evaluated before inducing mydriasis and/or cycloplegia. The technical procedures for the oblique illumination shadow test and the van Herick slit lamp test are presented, both of which provide an accurate estimation of the anterior chamber angle. The risk of precipitating an attack after reasonable circumspection by such evaluations approaches zero. However, should an attack occur, the procedures to rapidly lower the intraocular pressure and open the chamber angle are discussed.

Anterior Chamber↗
PubMed1998

Detection of diabetic retinopathy using non-mydriatic fundus photography at Chang Gung Memorial Hospital.

BACKGROUND: Despite recent improvements in the care of diabetic patients, diabetic retinopathy remains the most common cause of blindness among the diabetic population. The aim of this study is to identify the incidence and severity of diabetic retinopathy among diabetic patients followed-up at the metabolic clinics of the Chang Gung Memorial Hospital in Taoyuan, Taiwan. MATERIALS AND METHODS: We investigated the retinas of diabetic patients who were followed-up at the metabolic clinics and received non-mydriatic fundus photograph from April 1994 through June 1994. RESULTS: There were 694 patients with type 2 diabetes enrolled in this study. Their mean age was 56.2 +/- 11.1 years and the mean number of years since diagnosis was 5.9 +/- 5.7 years. Among them, 171 (25%) patients had diabetic retinopathy, including 109 (15.7%) background, 45 (6.5%) preproliferative and 17 (2.4%) proliferative cases. The presence of diabetic retinopathy correlated with the number of years since diagnosis of these diabetic patients (odds ratio: 1.03; p = 0.0024). CONCLUSION: Non-mydriatic fundus photography is a good screening method for diabetic retinopathy detection. Twenty-five percent of type 2 diabetic patients followed-up at our metabolic clinics had diabetic retinopathy with background retinopathy being the most predominant. The most significant risk factor of diabetic retinopathy is the number of years since the patient was diagnosed with diabetes.

Adult↗
PubMed1994

Mydriatic and antinociceptive effects of intrathecal dexmedetomidine in conscious rats.

A comparison was made of the dose-effect relationship of intrathecally applied dexmedetomidine as concerns its mydriatic and antinociceptive effects in rats. Pupil diameter was measured with a photographic method without anesthesia. Antinociception was measured by means of the tail-withdrawal test. The intrathecal (i.t.) administration of dexmedetomidine led to dose-dependent antinociception (P < 0.05) and mydriasis (P < 0.001). Both effects reached their maximum 10 min after drug application. The tail-withdrawal latency was prolonged by 9 micrograms dexmedetomidine. Mydriasis appeared on administration of a 1 microgram dose and its degree was proportional to the dexmedetomidine dosage up to 12 micrograms. A significant correlation was not found between pupil diameter and tail-withdrawal latency in the same rat after any dexmedetomidine dose. Based on the present experiments, we conclude that the mydriatic effect of i.t. dexmedetomidine appears at a lower dose than its antinociceptive effect. Our results suggest that the assessment of pupillary response is a sensitive method for estimation of the supraspinal effect of i.t. administered alpha 2-adrenoceptor agonists.

Adrenergic alpha-Agonists↗
PubMed1999

Development of a multi-field fundus photographing system using a non-mydriatic camera for diabetic retinopathy.

A new fundus photographing system was developed for diabetic subjects with or without simple diabetic retinopathy using a non-mydriatic fundus camera. Eight internal fixation targets were incorporated in a non-mydriatic fundus camera (TRC-NW5S; TOPCON, Tokyo, Japan), interfaced with a 3CCD color camera. Nine 45 degrees fundus photographs were taken in 22 healthy volunteers and 16 diabetic subjects, and stored as digital images. Fundus images were reconstituted as collages on the monitor and printed out. The combined angle reached 94 degrees in collage, and the average times required for photographing with and without mydriasis were 3 min 26 s and 4 min 36 s, respectively. The concordance of fundus images between the first and second photographs of healthy volunteers with and without mydriasis was 95.4% (n = 22). The quality of the photographs, graded on a five-point scale (5, full) by three doctors, was 4.3 +/- 0.6 in the volunteers without mydriasis, 4.7 +/- 0.4 in the diabetics without mydriasis, and 4.8 +/- 0.3 in the volunteers with mydriasis. In retinas with diabetic retinopathy, the system was able to depict microaneurysms, hemorrhages, hard exudates and soft exudates. This new system was satisfactory for the screening and follow-up of diabetic retinopathy.

Adult↗
PubMed1991

Detection of diabetic retinopathy in the community using a non-mydriatic camera.

The role of the non-mydriatic fundus camera in detection of diabetic retinopathy was evaluated as part of a comprehensive screening programme for diabetic complications offered to all diabetic patients in a rural town. Retinopathy was demonstrated in 124/358 (35%) of patients screened. Forty-eight patients (13%) were judged to have sight-threatening retinopathy, of whom 29 patients (8% of the total) were not already under the care of an ophthalmologist. However, in only 66% of patients were photographs of both eyes of adequate quality to assess for retinopathy. The percentage of poor quality photographs increased with age in those aged greater than 50 years. It is concluded that the non-mydriatic camera can increase the detection of sight-threatening retinopathy in the community. Although this method of screening is not perfect, because of the number of poor quality photographs, it may be as good as or better than existing screening practices in unselected diabetic populations.

Adolescent↗
PubMed1990

Screening for glaucoma with a non-mydriatic fundus camera.

183 first-degree relatives of glaucoma patients were photographed by a technician with non-mydriatic fundus camera in order to study the suitability of wide angle black-and-white fundus photographs in screening for glaucoma. The success rate of photography was 92%. The optic disc and retinal nerve fiber layer abnormalities were evaluated from the photographs by an ophthalmologist. 31 subjects (17%) were referred to further ophthalmological examinations. We found 6 (3%) new glaucomas. In addition, in 6 patients (3%) retinal nerve fiber layer defect was the only abnormality, 5 subjects (3%) showed a hemorrhage and 2 eyes had collateral vessels as a sign of asymptomatic venous stasis change at the optic disc. Only 1 of the 6 (17%) patients with glaucoma would have been found with tonometry alone. The results of this study indicate that non-mydriatic retinal camera is a useful tool in screening for glaucoma.

Adult↗
PubMed1988

Evaluation of a non-mydriatic camera in Indian and European diabetic patients.

The value of the Canon CR3-45NM non-mydriatic fundus camera in screening for diabetic retinopathy has been assessed in two ethnic groups, namely, 45 Indian and 40 European diabetic patients. There was 72% agreement between ophthalmoscopy by an ophthalmologist and the photographic assessment, and 100% agreement on clinically important lesions requiring treatment. However, peripheral retinal lesions, seen on ophthalmoscopy but lying outside the photographic field, occurred in 4% of eyes. 6% of photographs were totally unassessable and an additional 12% were only partially assessable. The prevalence and severity of retinopathy was similar in Indian and European patients. The advantages and disadvantages of the non-mydriatic camera in screening for diabetic retinopathy are discussed.

Diabetic Retinopathy↗
PubMed1988

Non-mydriatic Polaroid photography in screening for diabetic retinopathy: evaluation in a clinical setting.

Because of fears that Polaroid colour prints produced with a non-mydriatic fundus camera may not detect important sight threatening lesions in diabetes a study was conducted comparing retinal images obtained on Polaroid prints taken in "field" conditions with those on 35 mm transparencies and fluorescein angiograms. Almost one in five (22/127) Polaroid prints could not be assessed owing to poor quality compared with 3 (2.4%) 35 mm transparencies and 2 (1.6%) fluorescein angiograms. The pick up rate of microaneurysms, haemorrhages, and hard and soft (cotton wool spots) exudates was equivalent for Polaroid prints and 35 mm transparencies of equivalent quality. In two cases with disc new vessels, however, these were not seen on the Polaroid prints. The widespread use of Polaroid colour prints obtained with a non-mydriatic camera without the necessary operative and interpretive skills further limits the usefulness of the technique.

Diabetic Retinopathy↗
PubMed1998

Mydriatic pupil as the presenting sign of common carotid artery dissection.

BACKGROUND: Ipsilateral mydriasis is known to accompany signs of cerebral ischemia in unilaterally compromised carotid blood flow. Mydriasis as the presenting sign of common carotid artery (CCA) dissection has not been reported thus far. CASE DESCRIPTION: We report the case of a patient who presented with a mydriatic pupil after intraoperative injury of the ipsilateral CCA. Mydriasis preceded complete third-nerve palsy and symptoms of cerebral ischemia for 12 hours. Cerebral angiography revealed occlusion of the CCA with slow collateral flow to the internal carotid artery and fetal origin of the posterior cerebral artery, suggesting a hemodynamic mechanism causing ischemia of the oculomotor nerve. Signs of cerebral ischemia and third-nerve palsy resolved completely after reconstructive surgery of the occluded vessel. CONCLUSIONS: A mydriatic pupil may be the unusual first sign of compromised carotid blood flow and impending cerebral ischemia.

Adult↗
PubMed1994

Detection of retinopathy by non-mydriatic fundus photography in diabetics treated with oral hypoglycaemic agents or diet.

OBJECTIVE: To determine the prevalence of retinopathy by non-mydriatic fundus photography in diabetics treated with oral hypoglycaemic agents or diet. DESIGN: Cross-sectional survey of diabetes-induced fundal changes assessed by fundus photography. SETTING: Area of Health Centre of Oulu. Population 100,000. SUBJECTS: All 1,228 diabetic patients, aged 30 years or over and treated with oral hypoglycaemic agents or diet at the Health Centre of Oulu. MAIN OUTCOME MEASURES: Presence and severity of diabetic retinopathy in fundus photographs, need for laser photocoagulation, age, hypertension, body mass index (BMI), duration of diabetes, type of treatment of diabetes. RESULTS: Retinopathy was observed in 178 (18%) of those 1,015 diabetics examined at the health centre. Retinopathic changes requiring laser treatment were observed in 15 cases, and eight of them had not been diagnosed earlier. Sixty non-attenders photographed at the Central University Hospital were also included, and 12 of them had retinopathy. The presence of retinopathy was associated with long duration of diabetes, poor glycaemic control, and high systolic blood pressure. No association was detected with sex, age at onset of diabetes, BMI, medication for coronary artery disease, or hypertension. CONCLUSIONS: Non-mydriatic fundus photography detected a high prevalence of retinopathy in diabetic patients. Half of those with preproliferative changes were previously undiagnosed cases, and five were in need of immediate laser treatment. It is concluded that fundus photography is a useful tool for detecting retinopathy in a primary health care setting.

Adult↗
PubMed2004

[Validity of the non-mydriatic camera for diabetic retinopathy screening and analysis of retinopathy risk indicators].

PURPOSE: Analysis of the validity of the non-mydriatic camera in detecting diabetic retinopathy and severity levels which can be referred to the ophthalmologist. Analysis of risk indicators of diabetic retinopathy which help increase the sensitivity of the screening: development time of prolonged diabetes (more than 20 years); poor metabolic control (HbA1C > 10%). METHOD: A cross-sectional study was designed to determine the validity of a diagnostic test (non-mydriatic fundus camera Topcon model TRC-NW6S). As criteria for evaluation we used validity indicators, predictive values, indicators of clinical use, and concordance. SETTING: Primary Care. Patients with severe cataracts were excluded. The sample size was 376 eyes of 188 type-2 diabetic patients. RESULTS: With reference to the distribution of diabetic retinopathy we found that 41.25% had a variable level of retinopathy. The validity indicators analysed improved as the number of fundus fields studied increased, obtaining sensitivity levels of greater than 75%; specificity greater than 95%; positive predictive values greater than 90% and almost perfect concordance when two or three fundus fields were used. CONCLUSIONS: The analysis of retinal photography in digital format can be considered a valid method with respect to the gold standard, and the severity indicators analysed can play a guiding role in obtaining greater prevalences of derivable diabetic retinopathy, but cannot be used as an isolated test for making clinical decisions.

Cross-Sectional Studies↗
PubMed1998

Effectiveness of non-mydriatic retinal photography and direct ophthalmoscopy in detecting diabetic retinopathy.

This is a prospective study to compare the effectiveness of non-mydriatic photography with that of direct ophthalmoscopy in screening for diabetic retinopathy in 153 patients attending a hospital clinic in Hong Kong. Retinal photography under physiological mydriasis and direct ophthalmoscopy of patients with dilated pupils were compared with the ophthalmologists' examination results as a reference standard. The prevalence of diabetic retinopathy in this sample population was 15%. The sensitivity of detecting diabetic retinopathy by retinal photography was higher than that of direct ophthalmoscopy (64% versus 41%; 95% confidence interval of difference, 1.2%- 44.3%). Of five patients who had serious retinopathy, retinal photography failed to detect the disease in two; direct ophthalmoscopy failed to detect the disease in all five patients. Specificities of retinal photography and direct ophthalmoscopy were 90% (95% confidence interval, 84%-96%) and 93% (95% confidence interval, 88%-97%), respectively. We conclude that retinal photography is significantly more effective than direct ophthalmoscopy in detecting diabetic retinopathy. In addition, the non-mydriatic camera is easy to use and is the preferred method of screening.

Journal Article↗
PubMed1990

Ophthalmoscopy versus non-mydriatic fundus photography in the detection of diabetic retinopathy in black patients.

The contribution of non-mydriatic fundus photography in the detection of diabetic retinopathy before and after dilatation of the pupils in black diabetics was investigated and compared with direct ophthalmoscopy. Eighty-six patients were examined and good-quality photographs were obtained for 54.7% of eyes before and 86.6% of eyes after dilatation. Photographically documented retinopathy was detected by ophthalmoscopy in only 64.7% of eyes. The two methods were concordant for the presence of retinopathy in 62.2% of eyes before and 56.9% of eyes after dilatation. Photography through dilated pupils also improved the rate of detection of diabetic retinopathy from 24% to 30%. The 45 degrees non-mydriatic fundus camera was found to be a valuable adjunct in the detection of diabetic retinopathy in a busy diabetic clinic.

Adolescent↗
PubMed1984

Asymmetric mydriatic response to topical tyramine in cluster headache relatives.

A pupillometric study was performed to evaluate the mydriatic response to tyramine, a noradrenaline releaser. There were three groups of subjects: (a) 10 cluster headache patients, in an asymptomatic period; (b) 20 of their close relatives, exempt from this disease; (c) 10 healthy controls. The tyramine was instilled into both eyes of each subject. The controls displayed an isocoric tyramine-induced mydriasis but the cluster headache sufferers and their relatives showed an anisocoric mydriasis. This anisocoric mydriasis was caused by a deficient mydriatic response on one side, which in the cluster patients corresponded to the symptomatic side. The sympathetic abnormality of the iris may be the expression of a functional asymmetry in the hypothalamus. Central sympathetic asymmetry could thus represent a dysgenetic family predisposition to lateralized headache attacks.

Administration, Topical↗
PubMed1998

[Study of the efficiency of a non-mydriatic retinal camera in the diagnosis of diabetic retinopathy].

Diabetic retinopathy is one of the most important causes of blindness. Diabetic patients do not attend outpatient clinics with the necessary regularity for an early diagnosis of the most severe forms of retinopathy. A program was planned to compare the efficiency of a 45 degrees non-mydriatic retinal camera with a Polaroid instant film versus biomicroscopy with a 78D lens and reverse image ophthalmoscope (standard method) in the diagnosis of the presence and evolutive degree of retinopathy. In a cross-sectional epidemiologic study a questionnaire was administered to 258 randomly selected diabetic patients, 129 with and 128 without retinopathy. Information was collected of demographics, visual acuity, diabetes and resources used with each method. The eye fundus with the poorest visual acuity was examined to determine the presence and evolution of retinopathy with the two diagnostic methods. The photographic method had an overall sensitivity of 91.1%, a specificity of 89.7% and a level of agreement of 82% with the standard method. A cost-effective analysis revealed a decrease of 35.7% in the cost per true positive case detected with the photographic methods versus the standard method. The 45 degrees non-mydriatic retinal camera had a similar efficiency to the standard method used in our setting for the diagnosis of diabetic retinopathy, which together with a lower cost per patient renders this method advisable for its use in medical settings that usually control for potential ophthalmologic complications resulting from diabetes mellitus.

Adult↗
PubMed1980

Mydriatic solution for outpatient indirect ophthalmoscopy.

A mydriatic used for outpatient indirect ophthalmoscopy should produce prompt, maximal, transient mydrasis after a single instillation. Cycloplegia or systemic side effects should be minimal. A solution of tropicamide with phenylephrine hydrochloride seems to achieve this most effectively. In a general retina clinic population, the percentage of pupils dilated, the degree of dilation, and the resistence of the dilation to intense illumination were used to evaluate various concentrations of the drugs. Eight-tenths percent tropicamide with 5% phenylephrine adequately dilated 98.8% of the eyes, among which 25% had dark irides and 9% were receiving miotic therapy. Reduction of the concentration of either component produced less adequate mydriasis; an increase of the tropicamide concentration resulted in a saturated solution with drug precipitate forming on storage and a less adequate dilation. With the optimal combination, 1 drop adequately dilates the general population; 2 drops appear on more effective than 1.

Administration, Topical↗
PubMed1980

Tolerance to the Mydriatic effects of morphine in mice.

When injected to mice, opiates produce mydriasis. Animals treated chronically with morphine, developed tolerance to the mydriatic effects of morphine. The degree and consistency of the response make the pupil a valuable tool in opiate research.

Animals↗
PubMed1979

Mydriatic effect of anticholinergic drugs used during reversal of nondepolarizing muscle relaxants.

Large doses of anticholinergic drugs (atropine, glycopyrrolate) produced mydriasis in a group of adults with no eye abnormalities except strabismus, though the usual intramuscular and intravenous doses of these drugs do not have this tendency. Such large doses are often given intravenously during general anesthesia to prevent the side effects of neostigmine methylsulfate, which is used to reverse the effect of nondepolarizing muscle relaxants. Neostigmine methylsulfate (Prostigmin) reduced the mydriatic effect when given intravenously in conjunction with atropine or glycopyrrolate. Mydriasis was more likely to occur in lightly pigmented eyes than in eyes with dark irides. Pilocarpine eyedrops instilled at the beginning of anesthesia caused miosis that persisted after the large intravenous doses of atropine or glycopyrrolate were given. To prevent an attack of acute angle-closure glaucoma in any patient who is to receive large doses of anticholinergic drugs during general anesthesia, miotic drug therapy should be continued before, during, and after anesthesia at the same frequency as when awake.

Adolescent↗