近畿眼科先進医療研究会

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第38回近畿眼科先進医療研究会

日 時:
平成28年4月13日(水)18:00~19:00
場 所:
円形棟3階 小講堂
講 師:
Shizuo Mukai, M.D
Associate Professor,
Department of Ophthalmology,
Harvard Medical School
対象者:
近畿眼科先進医療研究会会員

研修テーマ:『Pediatric Retinal Imaging: Differentiating Posterior Segment Causes of Leukocoria to Designing Inexpensive Retinal Imaging Techniques and Devices 』

Shizuo Mukai, M.D

Associate Professor, Department of Ophthalmology,
Harvard Medical School

 

A variety of posterior segment conditions cause leukocoria in the pediatric eye. The most important is retinoblastoma which if misdiagnosed and/or mismanaged can cause blindness and even death. It is essential that pediatric ophthalmologists and retina specialists be able to differentiate retinoblastoma from other pediatric retinal conditions. These include lesions that are white or whitish, exudative processes, retinal detachments, and cells in the vitreous. The characteristic features of retinoblastoma such as color, calcification, vascular pattern, and seeding can be seen by ophthalmoscopy, and an examination by a specialist experienced in retinoblastoma is the most accurate way to diagnose this disease. Certainly, each of the other masquerading entities has characteristic features, and the ability of the examiner to distinguish these features is essential for correct diagnosis.

Since many of the clinical features mentioned above can be seen by ophthalmoscopy, fundus photography is able to record these features. Traditionally, this has been important for documentation, follow up, teaching, presentation, and publications. More recently with advances in digital technology, telemedicine of various forms has become an important part of our practice. Unfortunately, the fundus cameras are expensive, some costing upwards of $200,000, and in addition to cost, there are issues with different power supplies, software, portability, and service. We felt the need to develop low-cost, portable, readily available, simple-to-use fundus photography systems. We have designed a system to take good quality fundus photographs using a smartphone and a 20 D lens. We measured the safety of this system for at least one of the phones (iPhone 4), and the system is used by many ophthalmology centers in the United States. Our colleagues at Wills Eye Institute demonstrated that this system takes better photographs than standard fundus cameras under certain conditons. By using different condensing lenses and working distances, we can take fundus photographs in rabbits (28D) and mice (60D). This is important since many eye experiments are done in these animals. We have been able to modify the system by adding appropriate filters to perform fluorescein angiography and in vivo fluorescence photography of fluorescent markers in gene-therapy experiments in mice. Finally, we have a prototype nonmydriatic fundus camera based on the Raspberry Pi computer that attaches as a dongle to an Android phone. Once we check the safety of this system, we plan to have the entire information of this device available open source. The total cost of the materials for this device without the phone is $90.

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