Browsing by Author "Carvalho, Tiago"
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- Choroidal and retinal imaging biomarkers in age-related macular degeneration and vitamin D supplementation: a reviewPublication . Fernandes, Nádia; Araújo, Marta; Lança, Carla; Carvalho, TiagoAge-related Macular Degeneration (AMD) is a chronic and multifactorial aging retinal disease that causes irreversible central vision loss. In Europe, AMD represents the main cause of severe visual impairment and blindness in the elderly. Health status, low antioxidant diet, and sedentary lifestyles are modifiable risk factors. Health promotion and preventive medicine are essential to reduce the risk of disease progression and visual impairment. Vitamin D [25(OH)D] (Vit D) deficiency may be a risk factor for AMD. The anti-inflammatory potential of Vit D in AMD and its contribution to improving retinal antioxidant protection has been investigated. A systematic review and meta-analysis conducted by Ferreira et al. showed there was a trend for advanced AMD in people with serum Vit D<50nmol/L. Thus, increasing 25(OH)D levels through dietary intake and supplementation may be beneficial. A structural evaluation using SD-OCT and OCT-A seems to be an interesting tool for assessing changes in the retina and choroid after supplementation.
- Choroidal metastasis vs choroidal nevus - EDI OCT findings: case reportsPublication . Carvalho, Tiago; Fernandes, NádiaEnhanced depth imaging optical coherence tomography (EDI-OCT) is a novel imaging modality that has helped retina specialists learn more about the choroid’s role in the eye. As a health professional who develops teamwork with specialists, an orthoptist must know about the higher-resolution images and improved imaging acquisition of lesions that EDI-OCT provides. This poster summarizes the EDI-OCT findings between two clinical entities: choroidal metastasis and choroidal nevus.
- Evaluation of capillary perfusion level of the optic nerve head in glaucomatous optic neuropathy - structure/function correlation: case reportsPublication . Carvalho, Tiago; Fernandes, NádiaGlaucoma is a complex optic neuropathy characterized by a progressive loss of ganglion cell complex (GCC) and nerve fiber layer and consequently visual function loss. Although evaluation of glaucomatous structural damage in the optic nerve head (ONH) is fundamental to the diagnosis and management of glaucoma. Some researchers have suggested that vascular dysfunction plays an important role in the pathology of glaucoma. However, due to the limits of technology, few reports have studied microcirculation in glaucoma. Several methods have been used to measure optic nerve head perfusion in Glaucoma, many focusing on the peripapillary capillaries.
- Importance of macular ganglion cell complex evaluation in pituitary macroadenoma: case reportsPublication . Carvalho, Tiago; Fernandes, NádiaPituitary adenomas (PA) are the most common tumor of the Sella turcica brain region, accounting for 12–15% of symptomatic intracranial brain tumors. Usually occurs in adults with no gender predilections. Using Cranial Tomography (CT) and Magnetic Resonance Imaging (MRI) (Fig.1) is possible to classify it as a macroadenoma when size is ≥10 mm. The tumor compression on the optic nerve or chiasm leads to axonal damage that causes visual field (VF) defects, thinning of the retinal nerve fiber layer (RNFL), and a reduction in the macular ganglion cell complex (GCC) thickness measured by Optical coherence tomography (OCT). We present two clinical cases with different management approaches based on a previous structure-function evaluation.
- Low vision rehabilitation program in myopic macular degeneration: a case reportPublication . Fernandes, Nádia; Araújo, Marta; Carvalho, Tiago; Lança, CarlaIntroduction: Patients with high myopia are at risk of developing myopic macular degeneration (MMD), which leads to vision loss and irreversible visual impairment. Elderly populations are affected by loss of quality of life. Low vision services should offer specialized training programs to help patients overcome difficulties in daily living activities. This study aimed to describe the results of a low vision rehabilitation program (LVR) in a patient with MMD. Methods: A 69-year-old male patient with MMD was included in the LVR at an ophthalmology clinic in Portugal. The LVR had a length of 8 weeks and was divided into two phases. The first phase included the use of prisms for image relocation (IR) with eccentric viewing exercises to stabilize the preferred retinal locus. In the second phase, training with low-vision aids was performed. Best corrected visual acuity (BCVA) for distance and near, contrast sensitivity (CS), reading speed (RS) and face recognition were compared pre and post-rehabilitation. Additionally, the patient had open-angle glaucoma that was treated (glaucoma eye drops and neuroprotection treatment) and monitored by Spectral-domain optical coherence tomography.
- Low vision rehabilitation program in patients with myopic macular degeneration: a case seriesPublication . Fernandes, Nádia; Pereira, Débora; Carvalho, Tiago; Lança, CarlaAims/Purpose: Patients with pathologic myopia are at risk of developing myopic macular degeneration (MMD) that leads to vision loss and irreversible visual impairment. Working-age and elderly populations are affected by loss of productivity and quality of life. Low vision services should offer specialized training programs to help patients overcome difficulties in daily living activities. This study aimed to describe the results of a low vision rehabilitation program (LVR) in patients with MMD. Methods: Five patients (8 eyes) with MMD were included in the LVR at an ophthalmology clinic in Portugal. The LVR had a length of 8 weeks and was divided into two phases. The first phase included the use of prisms for image relocation (IR) with eccentric viewing exercises to stabilize the preferred retinal locus. In the second phase, training with low-vision aids was performed. Best corrected visual acuity (BCVA) for distance and near, contrast sensitivity (CS), reading speed (RS) and face recognition were compared pre and post-rehabilitation. Results: Patients had MMD category 3 (patchy chorioretinal atrophy) and 4 (macular atrophy) in the best eye. Vision impairment varied between mild and severe. The IR prisms varied from 2 to 6 prism dioptres. Electronic devices were the most prescribed low-vision aids. At the end of the LVR, the outcomes were good in all patients. BCVA increased by two to three lines, CS increased by two to four lines, RS increased by 40 to 60 words per minute, and face recognition improved in all patients. Conclusions: The LVR was beneficial, improving visual function and functional vision outcomes in all patients. LVR programs seem to be effective in patients with pathologic myopia. Longitudinal studies are necessary to ascertain the long-term efficacy of LVR.
- Protozoan eye infections: the challenges of human-animal-ecosystem interactionsPublication . Fernandes, Nádia; Araújo, M.; Carvalho, Tiago; Lança, CarlaBackground. Parasitic infections are significant causes of ophthalmic diseases worldwide, and if not treated timely, they could lead to visual impairment and blindness. Acanthamoeba species and Toxoplasma gondii are the most common protozoal parasites that infect the ocular structure. Prevention methods differ for each pathogen, but several practices are recognized as effective in reducing the risk at the community and personal levels. Education campaigns to promote handwashing after contact with animals and other behavioural adjustments can reduce the community spread of the disease. This study aims to increase awareness of protozoal parasite infections by describing two clinical cases that were diagnosed early and were effectively treated. Methods. A case of a 52-year-old Portuguese man with Acanthamoeba keratitis (patient 1) and a case of a 41-year-old Brazilian man (patient 2) are presented. Complete ophthalmologic examination including best-corrected visual acuity, slit lamp biomicroscopy, dilated biomicroscopic and fundus examinations, specular microscopy, colour fundus photography, and optical coherence tomography was performed at the diagnostic assessment and during the follow-up. The therapeutic strategy was a combination of classic therapy, anti-parasitic, and supplementation (antiinflammatory, pro-immune, and antioxidant properties) that modulate the host immune response. Results. Patient 1 was diagnosed with Acanthamoeba keratitis in both eyes after abusive use of contact lenses; all layers of corneal structure were damaged with higher severity in the left eye; the patient had light perception, photophobia, and hyperaemia; a therapeutic protocol with anti-fungal, anti-septic, anti-parasitic, artificial tear eye drops, vitamin C, D, zinc, copper and selenium was prescribed; after six weeks the patient presented maximum (1.0) visual acuity in both eyes and recovery of corneal layers, with guttate endothelium; non-use of contact lenses was indicated until total infection control. Patient 2 was diagnosed with Toxoplasmosis in the right eye with chorioretinal lesions; the patient was only able to see hand movements; a therapeutic protocol with antibiotic, anti-inflammatory, corticosteroids, bacterial folic acid inhibitor, vitamin C, D, zinc, copper, and selenium was prescribed; after four weeks the patient present better (0.3) visual acuity, resorptive chorioretinal lesion; dietary care recommendations were made. Conclusions. Our results support that early detection (by ocular imaging) and pharmacological therapy (that supports the immune system) lead to recovery of visual function and improvement in quality of life. Health promotion activities and community engagement may be critical to promoting habits and attitudes that reduce the risk of infections, supporting early detection and containment of disease threats. Eye health professionals may be key players in supporting The One Health approach regarding protozoan eye infections.