Fundus Pathology Research Articles

Results of Quantitative and Qualitative Assessment of Color Vision in Patients with Congenital Partial Atrophy of the Optic Nerve

Background. Congenital partial atrophy of the optic nerve is one of the main causes of blindness and low vision in patients with fundus pathology, and the study of color vision is important in diagnosis and monitoring visual functions in patients with this disease.Purpose: to study the possibilities of using the own developed method of quantitative and qualitative assessment of color vision in patients with partial optic nerve atrophy.Materials and methods. 55 patients aged from 8 to 20 years with congenital partial atrophy of the optic nerve (PAON) with a typical fundus pattern and EFI indicators for this disease were observed. The control group included 116 people of the same age without fundus pathology and with normal visual acuity. To study color vision in both groups, the classic FarnsworthMunsell Dichotomous D15 Test and the own developed method for quantitative and qualitative assessment of color vision were used.Results. The method developed by us made it possible to identify color perception disorders of varying severity in the majority (about 90 %) of patients with PAON. In the control group, no color perception disorders were detected in more than 70 % of the subjects. Quantitative assessment of color vision conducted using the method developed by us demonstrates significantly higher indicators of the total error of perception of color tones in patients with PAON (35.6 ± 3.2 degrees for a better-seeing eye and 39.9 ± 3.3 degrees for a worse-seeing eye) in comparison with the subjects of the control group (6.2 ± 1.1 degrees for a better-seeing eye and 7.5 ± 1.3 degrees for a worse-seeing eye). The severity of color perception disorders in patients with PAON does not depend on age, but has a significant inverse relationship with visual acuity. In the group of patients with PAON, when examining both better-seeing eye and worse-seeing eye, perception disorders of all color tones are detected with a slight predominance of disorders of perception of red, green and blue. The method developed by us has sufficiently higher sensitivity and specificity in comparison with the classic Farnsworth-Mansell D-15 test.Conclusion. The method developed by us makes it possible to effectively carry out a quantitative and qualitative assessment of the state of color perception in patients with PAON.

Development and validation of a deep learning model to predict axial length from ultra-wide field images.

To validate the feasibility of building a deep learning model to predict axial length (AL) for moderate to high myopic patients from ultra-wide field (UWF) images. This study included 6174 UWF images from 3134 myopic patients during 2014 to 2020 in Eye and ENT Hospital of Fudan University. Of 6174 images, 4939 were used for training, 617 for validation, and 618 for testing. The coefficient of determination (R2), mean absolute error (MAE), and mean squared error (MSE) were used for model performance evaluation. The model predicted AL with high accuracy. Evaluating performance of R2, MSE and MAE were 0.579, 1.419 and 0.9043, respectively. Prediction bias of 64.88% of the tests was under 1-mm error, 76.90% of tests was within the range of 5% error and 97.57% within 10% error. The prediction bias had a strong negative correlation with true AL values and showed significant difference between male and female (P < 0.001). Generated heatmaps demonstrated that the model focused on posterior atrophy changes in pathological fundus and peri-optic zone in normal fundus. In sex-specific models, R2, MSE, and MAE results of the female AL model were 0.411, 1.357, and 0.911 in female dataset and 0.343, 2.428, and 1.264 in male dataset. The corresponding metrics of male AL models were 0.216, 2.900, and 1.352 in male dataset and 0.083, 2.112, and 1.154 in female dataset. It is feasible to utilize deep learning models to predict AL for moderate to high myopic patients with UWF images.

Prevalence and Risk Factors of Fundus Pathology in Patients with Type 2 Diabetes in a Northeastern Chinese Cohort

ABSTRACT Purpose To assess the prevalence of and risk factors for fundus pathology in patients with type 2 diabetes mellitus (T2DM) in a cohort from northeastern China. Methods Patients were included from the Fushun Diabetic Retinopathy Cohort Study. Patients aged ≥ 30 years with T2DM were recruited between July 2012 and May 2013. Fundus pathology included retinal vascular occlusion (RVO), age-related macular degeneration (AMD), macular pathology, pathologic myopia (PM) and glaucomatous optic atrophy (GOA). Results A Total of 1998 patients with gradable fundus photographs were included in this study, of whom 388 (19.42%) had fundus pathology regardless of whether they had diabetic retinopathy (DR). There were 187 (9.36%) patients with AMD, 97 (4.85%) with GOA, 67 (3.35%) with macular pathology, 35 (1.75%) with PM and 23 (1.15%) with RVO. Advanced age was significantly associated with AMD (odds ratio (OR), 95% confidence interval (CI): 1.03, 1.01–1.05), macular pathology (OR, 95% CI: 1.06, 1.03–1.09) and GOA (OR, 95% CI: 1.06, 1.04–1.09). A wider central retinal arteriolar equivalent was protective against PM (OR, 95% CI: 0.78, 0.66–0.92). Wider central retinal venular equivalent was a protective factor for PM (OR, 95% CI: 0.75, 0.68–0.82) and GOA (OR, 95% CI: 0.93, 0.87–0.99). Conclusions One-fifth of these patients in northeast China with T2DM had fundus pathology regardless of whether they had DR, indicating the importance of early screening and long-term follow-up.

A New Vessel-Based Method to Estimate Automatically the Position of the Nonfunctional Fovea on Altered Retinography From Maculopathies.

The purpose of this study was to validate a new automated method to locate the fovea on normal and pathological fundus images. Compared to the normative anatomic measures (NAMs), our vessel-based fovea localization (VBFL) approach relies on the retina's vessel structure to make predictions. The spatial relationship between the fovea location and vessel characteristics is learnt from healthy fundus images and then used to predict fovea location in new images. We evaluate the VBFL method on three categories of fundus images: healthy images acquired with different head orientations and fixation locations, healthy images with simulated macular lesions, and pathological images from age-related macular degeneration (AMD). For healthy images taken with the head tilted to the side, the NAM estimation error is significantly multiplied by 4, whereas VBFL yields no significant increase, representing a 73% reduction in prediction error. With simulated lesions, VBFL performance decreases significantly as lesion size increases and remains better than NAM until lesion size reaches 200 degrees2. For pathological images, average prediction error was 2.8degrees, with 64% of the images yielding an error of 2.5 degrees or less. VBFL was not robust for images showing darker regions and/or incomplete representation of the optic disk. The vascular structure provides enough information to precisely locate the fovea in fundus images in a way that is robust to head tilt, eccentric fixation location, missing vessels, and actual macular lesions. The VBFL method should allow researchers and clinicians to assess automatically the eccentricity of a newly developed area of fixation in fundus images with macular lesions.

Comparison of the efficacy and safety of ultrasonic cycloplasty vs valve implantation and anti-VEGF for the treatment of fundus disease-related neovascular glaucoma.

To compare the clinical efficacy and safety of ultrasonic cycloplasty (UCP) vs Ahmed glaucoma drainage valve implantation (ADV) in addition to intravitreal anti-vascular endothelial growth factor (VEGF) for treatment of fundus disease-related neovascular glaucoma (NVG). A total of 43 patients (45 eyes) with NVG secondary to fundus diseases underwent anti-VEGF combined with UCP or ADV from August 2020 to March 2022 were enrolled in this retrospective cohort study. Of them, 14 patients (15 eyes) were treated with both UCP and anti-VEGF as the UCP group and 29 patients (30 eyes) treated with both ADV and anti-VEGF as the ADV group. The success of the treatment was defined as intraocular pressure (IOP) between 11-20 mm Hg with or without using IOP-lowering drugs. IOP measurement, IOP lowering drugs at baseline and follow-ups period and complications were recorded. The average age was 63.03±9.95 and 52.27±12.89y in ADV and UCP groups, respectively (P=1.947). The fundus pathology included proliferative diabetic retinopathy in 42 eyes and retinal vein occlusion in 3 eyes. All eyes in both groups achieved successful treatment at 3mo. While the success rate was 90.0% (27/30) in the ADV group and 86.7% (13/15) in the UCP group at the last follow-up of 6mo (P>0.05). IOP was significantly lower with reduction of drug use than the baseline in both groups (both P<0.05). And the ADV group needed fewer anti-glaucoma drops than the UCP group from 1d to 3mo. The comfort scores of patients in the ADV group were significantly lower than those in the UCP group in the first week after the operation (P<0.05). UCP is an alternative to the ADV with the same efficacy but non-invasive for the treatment of NVG.

Choroidal Vascular Density Quantification in High Myopia with or without Choroidal Neovascularization Using Optical Coherence Tomography Angiography.

The aim of this study was to analyze choroidal vascular density alteration in high myopia with or without choroidal neovascularization by using optical coherence tomography angiography (OCTA). This was a cross-sectional, observational study that included 60 high-myopia eyes. All the participants had comprehensive ophthalmic assessments with visual acuity, intraocular pressure, slit lamp-assisted biomicroscopy, color fundus photography, axial length, optometry, and OCTA. Age, sex, and comorbidities were collected from their medical charts. Univariate and multiple analyses were made to compare the age, spherical equivalent, choroidal vascular density, gender, and choroidal thickness between normal and patients with choroidal neovascularization. 60 eyes with high myopia were included in our study, including 30 eyes with choroidal neovascularization and 30 eyes without choroidal neovascularization or other fundus pathology. The mean age of high myopic patients was older in the choroidal neovascularization group than in the normal group (48.43 ± 19.06 years vs. 28.83 ± 9.92 years, p < 0.01). The mean choroidal thickness of high myopic patients was thinner in the neovascularization group than in the normal group (68.81 ± 48.81 μm vs. 137.80 ± 66.33 μm, p < 0.01). The mean choroidal vascular density in the normal group was greater than in the choroidal neovascularization group (82.43 ± 8.73 vs. 67.54 ± 12.56, p < 0.01). There was no significant difference in spherical equivalent between the choroidal neovascularization group and the normal group (-10.56 ± 2.97D vs. -11.93 ± 3.38D, p = 0.11). Multivariate analysis showed that after adjusting for covariates, less choroidal vascular density and older age were independent factors associated with choroidal neovascularization in the high myopic eye. Decreased choroidal vascular density and older age played an important role in the development of choroidal neovascularization in high myopic eyes. OCTA may help us to identify the highly myopic patients that need to intervene.

Fundoscopy use in neurology departments and the utility of smartphone photography: a prospective prevalence and crossover diagnostic accuracy study amongst neurology inpatients.

Background and purposeAlthough fundoscopy is a crucial part of the neurological examination, it is challenging, under‐utilized and unreliably performed. The aim was to determine the prevalence of fundus pathology amongst neurology inpatients and the diagnostic accuracy of current fundoscopy practice compared with systematic screening with smartphone fundoscopy (SF) and portable non‐mydriatic fundus photography (NMFP).MethodsThis was a prospective cross‐sectional surveillance and diagnostic accuracy study on adult patients admitted under neurology in an Australian hospital. Inpatients were randomized to initial NMFP (RetinaVue 100, Welch Allyn) or SF (D‐EYE) followed by a crossover to the alternative modality. Images were graded by neurology doctors, using telemedicine consensus neuro‐ophthalmology NMFP grading as the reference standard. Feasibility parameters included ease, comfort and speed.ResultsOf 79 enrolled patients, 14.1% had neurologically relevant pathology (seven, disc pallor; one, hypertensive retinopathy; three, disc swelling). The neurology team performed direct ophthalmoscopy in 6.6% of cases and missed all abnormalities. SF had a sensitivity of 30%–40% compared with NMFP (45.5%); however, it had a lower rate of screening failure (1% vs. 13%, p < 0.001), a shorter examination time (1.10 vs. 2.25 min, p < 0.001) and a slightly higher patient comfort rating (9.2 vs. 8/10, p < 0.001).ConclusionOur study demonstrates a clinically significant prevalence of fundus pathology amongst neurology inpatients which was missed by current fundoscopy practices. Portable NMFP screening appears more accurate than SF, whilst both are diagnostically superior to routine fundoscopic practice, feasible and well tolerated by patients.

Monocular Depth Estimation (Literature Review)

Background. The physiological basis of spatial perception is traditionally attributed to the binocular system, which integrates the signals coming to the brain from each eye into a single image of the three-dimensional outside world. The perception of three-dimensionality, however, is also possible due to the evolutionarily older monocular system of spatial perception. Normally, the binocular mechanism plays the leading role in depth perception, and its violations lead to a shift towards the monocular. In this regard, one of the relevant areas of ophthalmology and neurophysiology is the study of the features of monocular depth estimation in normal conditions and cases of ophthalmic pathology.Purpose: to study the literature data on the monocular depth estimation mechanism, methods of its assessment, as well as the peculiarities of its manifestations in normal conditions and cases of ophthalmic pathology.Materials and methods. The literature analysis of publications on PubMed, eLibrary, Cyberleninka and crossref metadata search was carried out.Results. The review considers modern ideas regarding monocular depth cues that can ensure the effective operation of the monocular mechanism of spatial vision. The stereokinetic effect (SE) is considered in detail. The possibilities of using SE assessment methods to evaluate the state of spatial vision mechanisms in cases of ophthalmic and neurological pathology have been studied.Conclusion. There are a number of monocular depth cues that can ensure the effective operation of the monocular mechanism of spatial vision, such as: perspective, light and color effects, accommodation and knowledge of the true sizes of the objects acquired with experience. Stereokinetic effect caused by the successive displacement of projections of circular eccentric images on the retina, which allows to evaluate relationship of monocular and binocular mechanisms of spatial perception, has a particular importance for ophthalmology practice. In patients with binocular vision disorders (amblyopia and strabismus), a decrease in monocular and an increase in binocular SE indicators were observed, whereas only a decrease in monocular indicators is more typical for organic ocular fundus pathology. At the same time, changes in SE indicators can serve as additional criteria for evaluating the efficacy of functional treatment of binocular disorders.

The history and prospects of the microperimetry method in diagnosis of pathologies of the macular region and the optic nerve

The article discusses the historical development stages of diagnostics of the functional state of the retina and the optic nerve using microperimetry in the Russian Federation and other countries, as well as the features and diagnostic prospects of the microperimetry method in identifying fundus pathologies.

Optical coherence tomography angiography for choroidal neovascularization in pathological myopia and neovascular age-related macular degeneration in combination with axial myopia in comparative analysis

Background. Optical coherence tomography angiography (OCTA) is currently an important method of visualization and assessment of fundus pathology in various diseases. The study of combined pathologies is not well covered.The aim: to compare OCTA features during choroidal neovascularization (CNV) in pathological myopia (PM) and in neovascular age-related macular degeneration in combination with axial myopia (nAMD + M) against the background of anti-VEGF therapy.Materials and methods. A prospective study included 70 eyes with active CNV. Comparative analysis of parameters was carried out between two groups: with PM – 47 eyes; with nAMD + M – 23 eyes.Results. 4 OCTA patterns were established in both groups: dense, loose, mixed and unidentifi able. With PM, dense pattern was found in 28 (59.57 %) eyes, loose pattern – in 16 (34.04 %), mixed pattern– in 2 (4.26 %), unidentifi able pattern – in 1 (2.13 %). In the nAMD + M group, dense pattern was rare – in 1 (4.35 %) eye, loose pattern – in 7 (30.44 %), mixed pattern – in 9 (39.13 %), unidentifi able pattern – in 6 (26.08 %). The fi rst group was characterized by a dense pattern that was found at a younger age, the second group was characterized by dense and mixed patterns. The greatest area and density of CNV were found with a loose pattern in both groups (p &lt; 0.05). The observation period until the stabilization of CNV was achieved was longer in the loose and mixed patterns in the PM group, and in the loose and unidentifi able – in the nAMD + M group (p &lt; 0.05). Loose and unidentifi able patterns require more injections. The halo was determined by the presence of intraretinal fluid in the retina. Conclusion. OCTA showed common features and distinctive features in the course of CNV in patients with PM and nAMD + M during anti-VEGF therapy. OCTA can be useful in assessing CNV activity and predicting the eff ect of treatment.

Development of a prototype service for the diagnosis of diabetic retinopathy based on fundus photos using artificial intelligence methods

Justification and purpose of the study. The high social significance of diabetic retinopathy (DR), the complexity of early diagnosis and monitoring of the disease determine the urgency of developing a system for diagnosing diabetic changes in the fundus using artificial intelligence (AI) methods. The aim of the work is to build a demo prototype of a WEB service for recognizing signs of DR from fundus images using machine learning methods using the Python language and the Django framework.Materials and methods. The study used the Messidor dataset (1200 eyes), which is publicly available on the Internet and includes photos of healthy fundus (546 eyes) and fundus with pathology (654 eyes). With the help of the augmentation method, this set for the study is increased several times. The fundus image recognition system is based on the trained neural network ResNet50. The web service with a connected neural network model was developed on the Django framework.Results. The main result of the research is the development of a test prototype of a service for the diagnosis of diabetic fundus changes based on photos using machine learning tools, demonstrating the great potential of using AI to improve the effectiveness of decisions. The sensitivity of the neural network model during the diagnosis of DR, even on a small test sample and limited training time, was 85 %.Conclusion. The high efficiency and potential of AI methods in the construction of a system for automatic detection of fundus pathology in the framework of the developed in the Helmholtz National Medical Research Center of Eye Diseases automated medical decision-making system. In the future, this service can be used to improve the effectiveness of early diagnosis and monitoring of diabetic changes in the fundus in conditions of reduced availability of primary ophthalmological care in parts of the Russian Federation, including at the pre-medical stage.

Impact on patient management of non-mydriatic fundus photography compared to direct ophthalmoscopy in a regional Australian emergency department.

To investigate the management impact of non-mydriatic fundus photography (NMFP) implementation for appropriate ED patients; compare the diagnostic accuracy of direct ophthalmoscopy (DO) and NMFP, and determine the prevalence of fundus pathology in a regional Australian ED. This before/after crossover study prospectively enrolled patients presenting with headache, neurological deficit, visual disturbance and/or hypertensive urgency. Patients received DO examination, then separate NMFP examination. Emergency clinicians (ECs) were surveyed on their patient management plans following both DO examination and NMFP imaging. Telemedicine review of NMFP images was performed by an ophthalmologist within 48 h, and any additional management changes were documented. The use of NMFP influenced changes in management in 52 (39%) of 133 enrolled patients (95% confidence interval 31-48%). Of these, 65% were escalations of management due to acute fundus pathology, while 35% were de-escalating changes following normal fundus findings. ECs diagnostic accuracy for acute fundus pathology improved from 0% to 29% sensitivity, and 59% to 84% specificity using DO and NMFP respectively, and telemedicine registrar review increased this to 50% sensitivity and 86% specificity. The period prevalence of acute fundus pathology was 10.5% (95% confidence interval 6-17%). The addition of NMFP images can significantly impact the management of ED patients requiring fundus examination, facilitating expedited and optimised patient care. NMFP improves ECs diagnostic acumen for fundus pathology over DO examination and telehealth specialist review is important for diagnostic accuracy. There is a clinically important prevalence of fundus pathology in this regional ED setting.

Multiple Evanescent White Dot Syndrome (MEWDS) Associated with Progression of Lacquer Cracks in High Myopia

To report a case of multiple evanescent white dot syndrome (MEWDS) associated with acute progression of lacquer cracks in high myopia. A 41-year-old female patient with high myopia developed typical signs, symptoms, and disease course of MEWDS in her right eye. At the same time, the same eye showed progression of lacquer cracks when compared to images taken 2 months prior. Retinal imaging findings characteristic of MEWDS were most obvious on fundus autofluorescence, whereas alterations on color fundus photography, optical coherence tomography, fluorescein, and indocyanine green angiography were very mild, probably because of the myopia-related fundus pathology. We present a case of MEWDS co-occurring with acute progression of lacquer cracks. This adds to the increasing evidence that impaired integrity of the retinal pigment epithelium-Bruch's membrane complex may be a factor in causing MEWDS, possibly by exposing otherwise isolated antigens. The anatomy in a highly myopic eye may make it challenging to diagnose MEWDS-associated fundus changes.

ATTEMPTING AN INDEPTH ANALYSIS OF RETINAL IMAGE SEGMENTATION

These days eye weaknesses are a typical issue in all age group individuals begins from a newborn child to mature age. The discovery and extraction of these infections is a troublesome and tedious assignment. Computerized retinal pictures are considered; the first important strategy is to separate vessel in fundus pictures. Thus, three methods are utilized regulated techniques; here, the training set applies to remove vessel data by the pre-trained algorithm. This strategy is physically dealt with using gold std; vessel extraction is done before pathology calculations are involved in unaided recognition and extraction programs. The preparation set and ground truth marking will not be straightforwardly appropriate to the analysis. Retinal vessels extraction is improving as a result of noninvasive imaging of the retinal pictures likewise the information got from the design of the vasculature, and this data is essential for the identification and analysis of a fundus picture retinal sicknesses and pathologies, which incorporates glaucoma, hypertension, Diabetics Retina chart, and Age-based Macula De-age. Quick division calculations can recognize these.

Prevalence of Ocular Diseases in Human Donor Eyes in New Zealand: A Study Based on Clinical and Histological Imaging.

Fundus pathology in donor eyes was correlated with cross-sectional Optical Coherence Tomography (OCT) images and histological assessment was performed to determine the prevalence of retinal diseases without the constraints imposed during in vivo clinical imaging. A fundus camera and OCT imaging system was adapted to enable posterior segment imaging of the entire post-mortem human eye. Retinas from 59 donors (57 retina pairs and two single globes) were imaged in a seven-field imaging format and cross-sectional analysis was done using OCT. To confirm that the signs observed represented true disease incidence analysis of disease markers including gliosis (Glial Fibrillary Acidic Protein), hemichannel expression (Connexin43), Müller cell activation (vimentin) and choroidal endothelial cells (CD-31) and macrophages (CD-68 marker) was performed. Pathological signs were correlated with clinical diagnoses in eyes from 25 donors (donor ages 45-87 years) but lesions were also found in 23 eyes (donor ages 39- 83 years) with no previously reported clinical diagnosis. Retinas from six donors aged 21-89 years of age were unremarkable. Of all donors, five donors had signs of age related macular degeneration (AMD) and 14 had signs of diabetic retinopathy (DR). Their lesions correlated with OCT and histopathology showed signs of activated microglia, Müller cell hyper-reactivity, increased Cx43 expression and choroidal inflammation. These data indicate that with over 8% of donors showing signs of AMD and 24% of donors showing signs of DR the incidence of AMD may be 1.7 times higher and DR up to 1.6 times higher than clinically reported. The detection of pathological signs characteristic of AMD and DR in donors suggests a higher prevalence of posterior segment abnormalities amongst New Zealanders donors than previously reported. A more detailed evaluation protocol of the posterior segment in patients will aid detection of lesions that are none the less pathological signs.

Optical coherence tomography-angiography as a non-invasive method of pathology diagnosis of the microcirculatory bed of the optic nerve and macula

The review discusses the development of optical coherence tomography with the function of angiography, focusing on its advantages, features, and prospects for the diagnosis of fundus pathologies.

Very low price smartphone fundus camera innovation with basic amenities – a novel approach toward undergraduate teaching

In this article, we introduce a very low-price smartphone fundus camera device with basic amenities. It has become very fruitful toward undergraduate teaching at the bedside or in the outpatient department, especially where there are no facilities for the fundus camera unit. A fundus camera unit is an essential part of retina clinic, and it is very costly. Fundus photographs are very essential for disease diagnosis, its follow-up, and for disease monitoring. It cannot be carried to the camp side. Commercially, available fundus cameras are the alternative to this, but again very costly. Almost zero price this innovation helps the students to see the fundus pathologies with their own eyes and make them more clinically oriented.

Comparing Eyesi Virtual Reality Simulator and Traditional Teaching Methods for Direct Ophthalmoscopy: Students' Perspectives at Indiana University School of Medicine

Abstract Background The fundus examination is an essential part of any ophthalmologic evaluation. However, medical students and primary care physicians often lack confidence with direct ophthalmoscopy. Virtual reality simulators are being employed in medical education to teach this technically challenging examination. Objective To compare medical student ratings of the Eyesi Direct Ophthalmoscope Simulator and traditional small group teaching methods for learning direct ophthalmoscopy skills. Methods All medical students at Indiana University School of Medicine traditionally learn direct ophthalmoscopy in their first 2 years during a small group session led by a physician instructor. Students who later enrolled in ophthalmology clinical electives during 2019 and 2020 were invited to additionally complete the Eyesi Direct Ophthalmoscope Simulator virtual reality curriculum. A voluntary, anonymous survey was sent between June and August 2020 to students who had completed both the traditional and Eyesi simulator sessions. Students were asked to rate their confidence in performing direct ophthalmoscopy following each session, and to indicate which teaching method was superior and why. Chi-square analysis was used to compare categorical variables. Results Students' confidence ratings for performing direct ophthalmoscopy were significantly higher following completion of the Eyesi simulator session compared with the traditional small group session (p &lt; 0.001). Four-fifths of respondents felt that the Eyesi simulator was superior to the traditional small group for learning the skills of direct ophthalmoscopy, while one-fifth felt that the two sessions were equally effective (p &lt; 0.001). None of the students responded that the small group session was the superior teaching method. Conclusion The Eyesi Direct Ophthalmoscope Simulator was rated highly among medical students and offers distinct learning advantages that could not be replicated in a traditional small group environment, such as providing numerous examples of pathological findings and allowing unlimited examination time without concern for patient's inconvenience or light exposure. The Eyesi simulator is a promising tool for teaching direct ophthalmoscopy to medical students. Ultimately, familiarity with the fundus examination will enable future physicians across specialties to better evaluate and appropriately refer patients with ocular fundus pathology.

Synthesis of neural network structure for the analysis of complex structured ocular fundus images

This paper proposes an algorithm for synthesizing a neural network (NN) structure to analyze complex structured, low entropy, ocular fundus images, characterized by iterative tuning of the adaptive model's solver modules. This algorithm will assist in synthesizing models of NNs that meet the predetermined characteristics of the classification quality. The relevance of automating the process of ocular diagnostics of fundus pathologies is due to the need to develop domestic medical decision-making systems. Because of using the developed algorithm, the NN structure is synthesized, which will include two solver modules, and is intended to classify the dual-alternative information. Automated hybrid NN structures for intelligent segmentation of complex structured, low entropy, retinal images should provide increased efficiency of ocular diagnostics of fundus pathologies, reduce the burden on specialists, and decrease the negative impact of the human factor in diagnosis.

Microaneurysms as a biomarker of diabetic retinopathy

Diabetic retinopathy is a microvascular pathology, which is the most common complication of diabetes mellitus. Improvement of instrumental diagnostics of retinal pathologies has contributed to identification of various phenotypes of the progression of ocular fundus pathology in diabetes based on specific changes in the retina - biomarkers. In particular, microaneurysms initially described in diabetes, which are a manifestation of a wide range of systemic pathologies and retinal diseases, are an indicator of the severity of diabetic retinopathy. Dynamic changes in the number of microaneurysms are a confirmed prognostic biomarker of clinically significant macular edema. In diabetic retinopathy, microaneurysms are one of the earliest recognizable signs, and the dynamic of their formation and disappearance may serve as a predictor for the disease progression. This literature review presents the characteristics of microaneurysms based on various imaging techniques, and analyses the link between structural features and dynamic changes in microaneurysms, and progression of diabetic retinopathy.