Diagnostic Technologies in Ophthalmology


by

Augusto Azuara-Blanco

DOI: 10.2174/97816080513351120101
eISBN: 978-1-60805-133-5, 2012
ISBN: 978-1-60805-320-9



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Indexed in: Scopus

This E-book provides the reader with a detailed up-to-date review of diagnostic technologies and their role in clinical practice. Chap...[view complete introduction]

Table of Contents

Foreword

- Pp. i

Anja Tuulonen

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Preface

- Pp. ii

Augusto Azuara-Blanco, Noemi Lois and Parwez Hossain

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List of Contributors

- Pp. iii-iv (2)

Augusto Azuara-Blanco, Noemi Lois and Parwez Hossain

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Diagnostic Studies - What the Clinician Needs to Know Regarding Methodology and Statistical Analysis of Assessments of a Diagnostic Test’s Performance

- Pp. 3-12 (10)

J.A. Cook

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Anterior Segment Imaging and Corneal Topography

- Pp. 13-30 (18)

Aristides Konstantopoulos and Parwez Hossain

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Clinical Applications of in vivo Confocal Microscopy

- Pp. 31-49 (19)

Antoine Labbé, Bénédicte Dupas and Christophe Baudouin

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Microbiology, Virology and Histopathological Sampling and Diagnosis

- Pp. 50-90 (41)

Samer Hamada and Saaeha Rauz

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Anterior Segment Optical Coherence Tomography and Angle Closure Glaucoma

- Pp. 91-98 (8)

Winifred Nolan

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Heidelberg Retina Tomograph in Glaucoma

- Pp. 99-112 (14)

N.G. Strouthidis and D.F. Garway-Heath

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Optical Coherence Tomography in Glaucoma

- Pp. 113-143 (31)

Allison K. Ungar, Gadi Wollstein and Joel S. Schuman

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Scanning Laser Polarimetry for Detection and Follow-up of Glaucoma

- Pp. 144-153 (10)

Gábor Holló

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Fast Visual Field Testing in the Diagnosis of Glaucoma

- Pp. 154-160 (7)

M. Gonzalez de la Rosa

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Optical Coherence Tomography in Neovascular Age-Related Macular Degeneration

- Pp. 161-169 (9)

Victor Chong

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Optical Coherence Tomography in Vitreomacular Disorders

- Pp. 170-197 (28)

A. Gaudric and R. Tadayoni

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Ocular Imaging in Diabetic Eye Disease

- Pp. 198-219 (22)

Catherine M. Guly and John V. Forrester

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Clinical Applications of Fundus Autofluorescence

- Pp. 220-237 (18)

Noemi Lois

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Electrophysiology Testing in Patients with Inherited Retinal Disease

- Pp. 238-271 (34)

V.A. McBain

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Index

- Pp. 272-274 (3)

Augusto Azuara-Blanco, Parwez Hossain and Noemi Lois

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Foreword

The new diagnostic technologies in eye care offer both huge opportunities and challenges. The goal of increasing number of more sensitive and reliable tests is to make earlier diagnosis and consequently improve patient outcomes. However, as simultaneously all countries are struggling with health care costs that are growing too large and too fast, there is a desperate need for high quality research to aid clinical decision making as to which is the best, most equitable and cost-effective way to spend the money. This eBook on diagnostics tests in ophthalmology aims to assess the criteria when to adopt new diagnostic technologies as well as when to abandon old and new diagnostic tests.

The best evidence of efficacy of all interventions is reached by randomized controlled trials. Randomized design has been widely applied in therapeutic studies but has been so far mostly non-existent in studies related to case finding, diagnostics tests and care practices as well as economic evaluation which deals with establishing a relationship between health effects and costs of the whole treatment process compared to another treatment process (efficiency).

A lot of unnecessary medical costs arise from the adoption of rapidly emerging and usually more expensive technologies which often enter clinical practice without adequate evaluation of their cost-effectiveness, especially in diagnostics. The optimum number of diagnostic tests in many eye diseases is not known, i.e. how many tests are enough and what number may represent over-testing with no additional gain incurring unnecessary expenditure. Earlier diagnostics may also lead to pseudo-disease, i.e. a disease that would never become apparent to patients during their lifetime without the diagnostic tests. In addition, majority of diagnostic studies have been performed on preselected patient populations, which may lead to over-optimistic results. The data of sensitivity and specificity of diagnostic tests in unscreened populations are often limited. Diagnostics studies may also suffer from lack of a true golden standard, e.g. in glaucoma where follow-up would probably represent the best option for golden standard.

Advanced diagnostic technologies and more frequent testing lead to more diagnoses - and more diagnoses lead to more treatment. With the shift in the spectrum of detected disease, newly detected cases will in general be milder cases and outcomes will seem to improve, which in turn will stimulate physicians to do even more testing. However, it is particularly the cumulative effect of small changes to clinical practice (e.g. adding a new diagnostic test or therapy) that has a massive impact on health care budgets.

Diagnostics offer large and highly elastic and expandable markets in common and often lifelong conditions which applied in early phases are usually less serious. For e.g. the definition of 'safe' intraocular pressure (IOP) that can easily be modified with huge increases in patient populations, ocular hypertensive patients are about 10 years younger than glaucoma patients and will therefore need tests 10 years longer; the increasing number of diagnostic tests and frequent follow-up testing in turn increase the possibility of finding at least some abnormal results among numerous new parameters and a third party pays for them in many countries.

At present, contrary to our beliefs, many health care decisions may be driven principally by values and resources (opinion-based medicine) or marketing strategies rather than by need or evidence-based medicine (EBM). Although EBM is so far the best tool for systematic critical appraisal of the literature, its methodology needs to be constantly evaluated and improved, too. It seeks the 'truth' without bias but is dependent on the quality of the evaluated studies. Guide lines based on best evidence may cause bias by positive phrasing of statements or recommendations for an intervention which – despite of low evidence – may more often lead to action than a negative recommendation (against for) an intervention would do. Due to different cultures and decision-making processes, different decisions may also result from the same evidence.

The most important question is, of course, whether the lower threshold for earlier diagnostics and more tests – despite the increase in costs – would be cost-effective in the long run in preventing visual disability. Such studies are not available at present. This eBook boldly attacks the challenges of diagnostic studies in eye care and offers many useful tools for clinical practice as well as suggestions for gaining high quality evidence in future.

Professor Anja Tuulonen (Finland)


Preface

Diagnostic Technologies in Ophthalmology

The field of ophthalmology has been revolutionized in recent years with the advent of new diagnostic technologies that allow clinicians to perform a better and more detailed evaluation of their patients with a non-invasive and safe test.

We conceived this eBook with the goal of providing the reader with a detailed up-to-date review of current knowledge on diagnostic techniques. Specifically, chapters are dedicated to describe the role of current technologies in the management of the leading causes of visual impairment such as age-related macular degeneration, diabetic retinopathy, glaucoma, vitreo-retinal disorders and cornea diseases.

It is our hope that this eBook will help the clinicians to understand and interpret diagnostic tests and critically appraise their performance and limitations. Although this eBook has been written for general ophthalmologists and those clinicians with a special interest in retinal diseases, glaucoma, anterior segment and cornea, it will also be of interest and value to ophthalmologists in training, scientists, ophthalmic photographers and optometrists.

There are 14 chapters in this eBook. The main assets of this eBook are the easy access of an e-eBook, its content (i.e., novel and clinically relevant information of diagnostic techniques in ophthalmology), and, most importantly, the collaborators who are all leading experts in each topic to whom we are indebted.

Augusto Azuara-Blanco
University of Aberdeen
Aberdeen
UK

Noemi Lois
Grampian University Hospitals-NHS Trust
University of Aberdeen
Aberdeen, Scotland
UK

Parwez Hossain
University of Southampton
UK

List of Contributors

Editor(s):
Augusto Azuara-Blanco
University of Aberdeen
Aberdeen
UK




Co-Editor(s):
Parwez Hossain
University of Southampton
UK


Noemi Lois
Aberdeeen Royal Infirmary
Aberdeen
UK




Contributor(s):
Augusto Azuara-Blanco
Health Services Research Unit
University of Aberdeen
Aberdeen
UK


Christophe Baudouin
Service d'ophtalmologie 3
Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts
Paris
France


Victor Chong
Oxford Eye Hospital
55 Fruit Street
Oxford
UK


Jonathan A. Cook
Health Services Research Unit
University of Aberdeen
Aberdeen
UK


Bénédicte Dupas
Service d'ophtalmologie 3
Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts
Paris
France


John V. Forrester
Department of Ophthalmology and Visual Sciences
University of Aberdeen
Aberdeen
UK


David F. Garway-Heath
NIHR Biomedical Research Centre for Ophthalmology
Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology
London
UK


Alain Gaudric
Department of Ophthalmology
Hopital Lariboisière
APHP-Université Paris Diderot
Paris
France


M. Gonzalez de la Rosa
Department of Ophthalmology
Faculty of Medicine
University of La Laguna
La Laguna
Spain


Catherine M. Guly
Department of Ophthalmology
Aberdeen Royal Infirmary
Aberdeen
UK


Samer Hamada
Academic Unit of Ophthalmology
School of Infection and Immunity
College of Medical and Dental Sciences
University of Birmingham
Birmingham and Midland Eye Centre
Birmingham
UK


Gábor Holló
Department of Ophthalmology
Semmelweis University
Budapest
Hungary


Parwez Hossain
Eye Unit, University of Southampton
Southampton University Hospitals NHS Trust
Southampton
UK


Aristides Konstantopoulos
Southampton Eye Unit
Southampton General Hospital
Southampton
UK


Antoine Labbé
Service d'ophtalmologie 3
Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts
Paris
France


Noemi Lois
Grampian University Hospitals-NHS Trust and University of Aberdeen
Aberdeen
Scotland
UK


Vikki A. McBain
Eye Out-patient Department
Aberdeen Royal Infirmary
Foresterhill
Aberdeen
UK


Winifred Nolan
Birmingham and Midland Eye Centre
Birmingham
UK


Saaeha Rauz
Academic Unit of Ophthalmology, School of Infection and Immunity
College of Medical and Dental Sciences, University of Birmingham, Birmingham and Midland Eye Centre
Birmingham
UK


Joel S. Schuman
Academic Unit of Ophthalmology
School of Infection and Immunity
College of Medical and Dental Sciences
University of Birmingham
Birmingham and Midland Eye Centre
Pennsylvania
USA


Nicholas G. Strouthidis
NIHR Biomedical Research Centre for Ophthalmology
Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology
London
UK


Ramin Tadayoni
Department of Ophthalmology
Hopital Lariboisière
APHP-Université Paris Diderot
Paris
France


Allison K. Ungar
Department of Ophthalmology, UPMC Eye Center
Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine
Pittsburgh
Pennsylvania
USA


Gadi Wollstein
Department of Ophthalmology
UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine
Pittsburgh
Pennsylvania
USA




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