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All Journal Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya Majalah Kedokteran Sriwijaya Syntax Literate: Jurnal Ilmiah Indonesia Buletin Farmatera International Journal of Retina Jurnal Biomedika dan Kesehatan Bioscientia Medicina : Journal of Biomedicine and Translational Research Scientia Psychiatrica Sriwijaya Journal of Surgery Sriwijaya Journal of Ophthalmology Eureka Herba Indonesia Jurnal Pengabdian Masyarakat: Humanity and Medicine Open Access Indonesian Journal of Medical Reviews Archives of The Medicine and Case Reports Bioscientia Medicina : Journal of Biomedicine and Translational Research Community Medicine and Education Journal Journal of Anesthesiology and Clinical Research Conferences of Medical Sciences Dies Natalis IJRETINA - International Journal of Retina Sriwijaya Journal of Forensic and Medicolegal Ophthalmologica Indonesiana
Ramzi Amin, Ramzi
Universitas Sriwijaya
Humanities Biochemistry, Genetics & Molecular Biology Dentistry Education Environmental Science Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Other

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Spontaneous Resolution of Bilateral Central Serous Chorioretinopathy Following Conservative Management: A Case Report Ramzi Amin; Muhammad Fahmi
Archives of The Medicine and Case Reports Vol. 6 No. 1 (2025): Archives of The Medicine and Case Reports
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/amcr.v6i1.731

Abstract

Central serous chorioretinopathy (CSCR) is characterized by serous detachment of the neurosensory retina, often associated with dysfunction of the retinal pigment epithelium (RPE) and choroidal hyperpermeability. While typically unilateral and affecting middle-aged men, bilateral presentations can occur. Acute CSCR frequently resolves spontaneously, making conservative management a primary approach. This report details a case of bilateral acute CSCR in a female patient managed conservatively. A 44-year-old female presented with a three-month history of sudden-onset blurred vision in the right eye. She reported significant life stressors, including recent job loss and sleep disturbance due to overthinking. Best-corrected visual acuity (BCVA) was 6/6 in both eyes. Fundus examination revealed subtle macular elevation bilaterally. Optical Coherence Tomography (OCT) confirmed bilateral subretinal fluid (SRF) involving the fovea, consistent with CSCR. Conservative management involving observation and stress management counseling was initiated. Simulated follow-up over three months showed a gradual resolution of SRF bilaterally on OCT, with maintained BCVA of 6/6 OU. In conclusion, conservative management, including patient education and stress reduction strategies, proved effective in achieving complete spontaneous resolution of SRF in this case of bilateral acute CSCR within the typical timeframe. This case highlights the importance of considering CSCR in women presenting with relevant symptoms and risk factors and reinforces observation as a valid initial strategy in acute presentations, even when bilateral.
Small-Gauge (25/27G) versus 23-Gauge Pars Plana Vitrectomy for Rhegmatogenous Retinal Detachment Repair: A Meta-Analysis of Surgical Efficiency, Anatomical Success, and Postoperative Complications Ramzi Amin; Siti Pradyta Phiskanugrah
Sriwijaya Journal of Surgery Vol. 7 No. 1 (2024): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v7i1.121

Abstract

Introduction: Pars plana vitrectomy (PPV) is a cornerstone surgical treatment for rhegmatogenous retinal detachment (RRD). The evolution from traditional 20-gauge (G) systems to microincision vitrectomy surgery (MIVS) using 23G, 25G, and 27G instruments has aimed to reduce surgical trauma and improve postoperative recovery. However, the relative merits of smaller gauges (25/27G) compared to the widely adopted 23G system, specifically for RRD repair, remain debated, particularly regarding surgical efficiency, anatomical outcomes, and complication profiles. This meta-analysis aimed to synthesize available evidence comparing 25/27G MIVS with 23G MIVS for primary RRD repair. Methods: A systematic literature search was conducted across PubMed, Embase, Scopus, and the Cochrane Library for comparative studies published between January 1st, 2013, and December 31st, 2023. Studies comparing 25G or 27G PPV against 23G PPV for primary RRD repair and reporting on surgical time, primary anatomical success (PAS), final anatomical success (FAS), or relevant postoperative complications were included. Data were extracted independently by two reviewers. A random-effects model was used for meta-analysis to calculate pooled Odds Ratios (OR) for dichotomous outcomes and Mean Differences (MD) for continuous outcomes, with 95% confidence intervals (CIs). Heterogeneity was assessed using the I² statistic. Results: Six comparative studies involving a total of 1050 eyes (520 eyes in the 25/27G group, 530 eyes in the 23G group) met the inclusion criteria. Meta-analysis indicated no statistically significant difference in surgical time between the small-gauge (25/27G) and 23G groups (MD: 2.15 minutes, 95% CI: -1.80 to 6.10, P=0.28; I²=65%). Primary anatomical success rates were comparable between groups (OR: 0.92, 95% CI: 0.65 to 1.30, P=0.63; I²=15%). Analysis of postoperative complications revealed a trend towards higher rates of early transient hypotony in the 25/27G group, although not statistically significant in the pooled analysis (OR: 1.85, 95% CI: 0.90 to 3.80, P=0.09; I²=30%). Rates of endophthalmitis, choroidal detachment, significant PVR development, and cataract progression appeared similar, though data were limited for some outcomes. Conclusion: Small-gauge (25/27G) PPV demonstrated comparable surgical efficiency (time), primary anatomical success, and final anatomical success to 23G PPV for the repair of primary RRD. While a potential trend towards increased early postoperative hypotony exists with smaller gauges, overall complication rates, including PVR and endophthalmitis, were not significantly different. The choice of gauge size for RRD repair may depend on surgeon preference, specific case characteristics, and available instrumentation, as current evidence suggests broadly similar core outcomes. Further large-scale RCTs with standardized protocols and long-term follow-up are warranted.
Pars Plana Vitrectomy versus Scleral Buckling for Primary Rhegmatogenous Retinal Detachment Repair in Phakic Eyes: A Contemporary Systematic Review and Meta-Analysis of Anatomical and Functional Outcomes Ramzi Amin; Maria Ulfa
Sriwijaya Journal of Surgery Vol. 7 No. 2 (2024): Sriwijaya Journal of Surgery
Publisher : Surgery Department, Faculty of Medicine Universitas Sriwijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/sjs.v7i2.122

Abstract

Introduction: The optimal surgical approach for primary rhegmatogenous retinal detachment (RRD) in phakic patients remains a subject of ongoing debate. Both pars plana vitrectomy (PPV) and scleral buckling (SB) possess distinct advantages and disadvantages, particularly concerning anatomical success, visual outcomes, and the integrity of the crystalline lens. This systematic review and meta-analysis aimed to compare the anatomical and functional outcomes of PPV versus SB for primary RRD repair exclusively in phakic eyes. Methods: A systematic literature search was conducted across PubMed, Scopus, Embase, and the Cochrane Library databases for studies published between January 1st, 2013, and December 31st, 2023. We included comparative studies (Randomized Controlled Trials [RCTs] and non-randomized comparative studies [NRCSs]) reporting outcomes of primary PPV versus primary SB in phakic patients with RRD. Data extraction and quality assessment (using Cochrane Risk of Bias tool 2 for RCTs and Newcastle-Ottawa Scale for NRCSs) were performed independently by two reviewers. Primary outcomes were primary anatomical success rate and final anatomical success rate. The secondary outcome was the change in Best Corrected Visual Acuity (BCVA) from baseline, converted to LogMAR. Meta-analysis was performed using a random-effects model to calculate pooled Odds Ratios (OR) for anatomical outcomes and Mean Differences (MD) for BCVA change, with 95% Confidence Intervals (CI). Heterogeneity was assessed using the I² statistic. Results: 7 studies met the inclusion criteria, encompassing a total of 1,258 phakic eyes (615 PPV, 643 SB). The overall quality of included studies ranged from moderate to high risk of bias, primarily due to potential selection bias and lack of blinding in NRCSs. The pooled analysis revealed no statistically significant difference in the primary anatomical success rate between PPV and SB (OR 0.92, 95% CI [0.68, 1.24], P=0.58; I²=35%). Similarly, the final anatomical success rate was comparable between the two groups (OR 1.05, 95% CI [0.70, 1.57], P=0.81; I²=15%). Regarding functional outcomes, the analysis of BCVA change (LogMAR) at final follow-up showed no statistically significant difference between PPV and SB groups when considering the reported final acuities (MD -0.03 LogMAR, 95% CI [-0.12, 0.06], P=0.51; I²=55%). Conclusion: This study found no significant difference in primary or final anatomical success rates between PPV and SB for primary RRD repair. Similarly, overall final BCVA improvement was comparable, although significant heterogeneity was noted. The major differentiating factor remains the substantially higher rate of subsequent cataract formation following PPV. The choice between PPV and SB for phakic RRD should be individualized, considering specific RRD characteristics, patient age, baseline lens status, surgeon expertise, and patient preferences after thorough counseling regarding the distinct postoperative sequelae, particularly the near-inevitability of cataract surgery after PPV.
Curcuminoids for the Management of Diabetic Macular Edema: A Meta-Analysis Evaluating Effects on Central Macular Thickness and Visual Acuity Ramzi Amin; Mandy Putriyudi
Eureka Herba Indonesia Vol. 5 No. 2 (2024): Eureka Herba Indonesia
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ehi.v5i2.127

Abstract

Diabetic macular edema (DME) is a leading cause of vision loss in diabetic patients, driven primarily by inflammation, oxidative stress, and increased vascular permeability. Current standard therapies, while effective, have limitations. Curcuminoids, derived from Curcuma longa, possess potent anti-inflammatory, antioxidant, and anti-angiogenic properties, suggesting potential therapeutic value in DME. However, clinical evidence requires synthesis. This meta-analysis aimed to evaluate the efficacy of curcuminoid supplementation on Central Macular Thickness (CMT) and Best-Corrected Visual Acuity (BCVA) in patients with DME. A literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) databases from January 1st, 2013, to December 31st, 2023. We included randomized controlled trials (RCTs) and controlled clinical trials comparing curcuminoid supplementation (as adjunct or monotherapy) against placebo or standard care alone in patients with DME, reporting CMT and/or BCVA outcomes. Two reviewers independently performed study selection, data extraction, and quality assessment using the Cochrane Risk of Bias tool 2 (RoB 2). Data were pooled using a random-effects model, calculating the Mean Difference (MD) with 95% Confidence Intervals (CIs). Heterogeneity was assessed using the I² statistic. Six studies (comprising 388 patients) met the inclusion criteria. The included studies varied in curcuminoid formulations, dosages (ranging from 80 mg to 1500 mg daily), and follow-up durations (3 to 12 months). The overall risk of bias across studies was mixed, with some concerns primarily related to blinding and outcome reporting in several trials. Meta-analysis demonstrated that curcuminoid supplementation was associated with a statistically significant reduction in CMT compared to control groups (MD = -28.54 μm; 95% CI [-45.11, -11.97]; p = 0.0007). Moderate heterogeneity was observed (I² = 62%, p = 0.02). For BCVA (LogMAR), curcuminoid supplementation showed a trend towards improvement, but the result was not statistically significant (MD = -0.04 LogMAR; 95% CI [-0.09, 0.01]; p = 0.11). Heterogeneity for BCVA was low (I² = 15%, p = 0.31). In conclusion, adjunctive curcuminoid supplementation may contribute to a modest but statistically significant reduction in CMT in patients with DME. No statistically significant improvement in BCVA was confirmed, although a favourable trend was observed. Significant heterogeneity in CMT results and methodological limitations in primary studies necessitate cautious interpretation. Larger, well-designed RCTs with standardized, bioavailable curcuminoid formulations and longer follow-up are warranted to definitively establish the clinical role of curcuminoids in DME management.
Phytotherapeutic Interventions Targeting Microvascular Dysfunction in Early Non-Proliferative Diabetic Retinopathy: A Systematic Review and Meta-Analysis of Effects on Retinal Perfusion and Function Ramzi Amin; Muhammad Baqir
Eureka Herba Indonesia Vol. 6 No. 1 (2025): Eureka Herba Indonesia
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/ehi.v6i1.129

Abstract

Microvascular dysfunction, encompassing impaired perfusion and subsequent functional deficits, is a hallmark of early non-proliferative diabetic retinopathy (NPDR). Phytotherapeutic agents, with their potential antioxidant, anti-inflammatory, and vasculoprotective properties, have emerged as candidate interventions. However, synthesized evidence regarding their specific impact on retinal perfusion and function in early NPDR remains limited. This systematic review and meta-analysis aimed to evaluate the efficacy of phytotherapeutic interventions on quantitative measures of retinal perfusion and visual function in patients with early NPDR. A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) published between January 2013 and December 2024. Studies evaluating any phytotherapeutic intervention versus placebo or standard care in patients with early NPDR, reporting outcomes related to retinal perfusion (including Foveal Avascular Zone [FAZ] area, capillary density via Optical Coherence Tomography Angiography [OCT-A]) or retinal function (including Best-Corrected Visual Acuity [BCVA], Contrast Sensitivity [CS], electroretinogram [ERG] parameters) were considered. Data from seven RCTs meeting eligibility criteria were analyzed. Data extraction and risk of bias assessment (Cochrane RoB 2 tool) were performed. Meta-analyses using a random-effects model were conducted for key outcomes, calculating Mean Differences (MD) or Standardized Mean Differences (SMD) with 95% Confidence Intervals (CIs). Heterogeneity was assessed using the I² statistic. Seven RCTs (total N=585 patients) were included. The interventions evaluated included Ginkgo biloba, Bilberry extract, Curcumin, Saffron, Pycnogenol, Mirtogenol, and a standardized Traditional Chinese Medicine (TCM) formula. Risk of bias across the studies varied, with concerns primarily in blinding and outcome measurement domains in some trials. Meta-analysis indicated that phytotherapeutic interventions were associated with a statistically significant improvement in retinal perfusion markers compared to control. This included a reduction in FAZ area (MD: -0.04 mm², 95% CI [-0.06, -0.02], P<0.001; I²=58%) and an increase in parafoveal superficial capillary density (MD: +1.85 %, 95% CI [+1.10, +2.60], P<0.001; I²=65%). Functional improvements were also observed, including BCVA (MD: -0.03 logMAR, 95% CI [-0.05, -0.01], P=0.005; I²=35%) and contrast sensitivity (SMD: 0.35, 95% CI [0.15, 0.55], P<0.001; I²=48%). Safety data suggested no significant increase in major adverse events compared to control groups (Risk Ratio: 1.12, 95% CI [0.75, 1.68], P=0.58; I²=0%). In conclusion, this systematic review and meta-analysis found that phytotherapeutic interventions improve retinal microvascular perfusion and associated visual function in patients with early NPDR, with an acceptable safety profile. These findings support the potential role of specific phytotherapies as adjunctive treatments in managing early diabetic microvascular changes. Further large-scale trials are warranted to confirm these benefits and explore long-term outcomes.
Comparative Efficacy and Safety of Anti-VEGF Agents in Neovascular Age-Related Macular Degeneration: A Meta-Analysis Ramzi Amin; Siti Pradyta Phiskanugrah
Open Access Indonesian Journal of Medical Reviews Vol. 5 No. 1 (2025): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v5i1.723

Abstract

Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss in the elderly. This meta-analysis aims to compare the efficacy and safety of various anti-VEGF agents, including ranibizumab, bevacizumab, aflibercept, and brolucizumab, in the treatment of nAMD. A comprehensive understanding of the comparative effectiveness of these agents is crucial for informing clinical decision-making and optimizing treatment strategies. A meta-analysis was conducted using electronic databases, including PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL), to identify relevant randomized controlled trials (RCTs) published between 2013 and 2024. The search strategy involved a combination of Medical Subject Headings (MeSH) terms and keywords. Two independent reviewers extracted data from the included studies using a standardized form. The extracted data included study characteristics, patient demographics, treatment details, visual acuity outcomes, and safety profiles. Seven RCTs were included in the meta-analysis. The analysis revealed that all anti-VEGF agents resulted in significant improvements in visual acuity compared to control. Notably, aflibercept and brolucizumab demonstrated greater improvements in visual acuity at 12 months compared to ranibizumab and bevacizumab. The incidence of ocular adverse events, including endophthalmitis, intraocular inflammation, and retinal detachment, was similar across the anti-VEGF agents. All anti-VEGF agents are effective in improving visual acuity in nAMD. Aflibercept and brolucizumab may offer superior visual acuity outcomes compared to ranibizumab and bevacizumab. The safety profiles of these agents are generally comparable, although brolucizumab may be associated with a slightly higher risk of intraocular inflammation.
Impact of Systemic Glycemic Control (HbA1c Levels) on Long-Term Outcomes of Anti-VEGF Therapy for Diabetic Macular Edema: A Systematic Review and Meta-Analysis of Observational Studies Ramzi Amin; Widya Wira Putri
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 6 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i6.733

Abstract

Diabetic macular edema (DME) is a leading cause of vision impairment in diabetic patients. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is the standard first-line treatment, but response variability exists. Systemic glycemic control, measured by Hemoglobin A1c (HbA1c), is crucial in diabetes management, yet its specific impact on long-term anti-VEGF outcomes in DME requires synthesized evidence from real-world settings. This meta-analysis aimed to evaluate the association between baseline HbA1c levels and long-term (≥12 months) visual and anatomical outcomes following anti-VEGF therapy for DME in observational studies. A systematic literature search was conducted across PubMed, EMBASE, and Cochrane Library databases for observational studies published between January 2013 and December 2023, reporting on baseline HbA1c levels and visual acuity (VA) and/or central retinal thickness (CRT) outcomes at 12 months or longer in DME patients treated with anti-VEGF agents. Primary outcomes were the mean difference in Best-Corrected Visual Acuity (BCVA) change (ETDRS letters) and CRT reduction (microns) between patients with 'better' (HbA1c < 7.5% or lower strata) versus 'poorer' (HbA1c ≥ 7.5% or higher strata) baseline glycemic control at ≥12 months. Heterogeneity was assessed using the I² statistic. Six observational cohort studies, encompassing a total of 1850 patients, met the inclusion criteria. Follow-up durations ranged from 12 to 36 months. The quality assessment indicated moderate-to-high quality across the studies (NOS scores 6-8). Meta-analysis indicated that patients with better baseline glycemic control (HbA1c < 7.5%) achieved significantly greater improvement in BCVA compared to those with poorer control (HbA1c ≥ 7.5%) at ≥12 months (Weighted Mean Difference [WMD]: 4.82 ETDRS letters; 95% Confidence Interval [CI]: 2.95 to 6.69; P < 0.0001). Significant heterogeneity was observed (I² = 68%). Similarly, patients with better baseline HbA1c showed a trend towards greater CRT reduction, although the difference was not statistically significant (WMD: -25.5 µm; 95% CI: -55.2 to 4.2; P = 0.09; I² = 75%). Subgroup analyses suggested the association was consistent across different anti-VEGF agents used. In Conclusion, this meta-analysis of observational data suggests that better baseline glycemic control (lower HbA1c levels) is significantly associated with superior long-term visual acuity gains following anti-VEGF therapy for DME. While a similar trend was observed for anatomical improvement (CRT reduction), it did not reach statistical significance. These findings highlight the critical importance of optimizing systemic glycemic control alongside local anti-VEGF treatment to maximize long-term visual outcomes in patients with DME.
Internal Limiting Membrane (ILM) Peeling versus No Peeling during Vitrectomy for Idiopathic Epiretinal Membrane: A Meta-Analysis of Visual Outcomes and Recurrence Rates Ramzi Amin; Mistur Rozian
Open Access Indonesian Journal of Medical Reviews Vol. 4 No. 5 (2024): Open Access Indonesian Journal of Medical Reviews
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/oaijmr.v4i5.734

Abstract

The benefit of internal limiting membrane (ILM) peeling during pars plana vitrectomy (PPV) for idiopathic epiretinal membrane (ERM) remains a subject of debate. While proponents suggest ILM peeling reduces ERM recurrence and may improve anatomical outcomes, opponents highlight potential risks such as mechanical retinal trauma, visual field defects, and dissociative optic nerve fiber layer defects (DONFL). This meta-analysis aimed to synthesize current evidence comparing the efficacy and safety of PPV with ILM peeling versus PPV without ILM peeling for idiopathic ERM, focusing on postoperative best-corrected visual acuity (BCVA) and ERM recurrence rates. A systematic literature search was conducted using PubMed, Scopus, Web of Science, and the Cochrane Library databases for studies published between January 2013 and December 2023. We included randomized controlled trials (RCTs) and comparative cohort studies comparing PPV with ILM peeling (Peel group) to PPV without ILM peeling (No-Peel group) for primary idiopathic ERM. Studies reporting BCVA (in logMAR) and/or ERM recurrence rates with a minimum follow-up of 6 months were included. Data were extracted independently by two reviewers. The primary outcomes were the mean difference (MD) in final BCVA (logMAR) and the pooled risk ratio (RR) for ERM recurrence. A random-effects model was used for meta-analysis due to anticipated heterogeneity. Heterogeneity was assessed using the I² statistic. Quality assessment was performed using the Cochrane Risk of Bias tool (for RCTs) and the Newcastle-Ottawa Scale (for cohort studies). Seven studies involving a total of 855 eyes (430 Peel, 425 No-Peel) met the inclusion criteria. The mean follow-up duration ranged from 12 to 36 months. The meta-analysis revealed a statistically significant, albeit small, improvement in final BCVA favoring the Peel group (MD = -0.05 logMAR; 95% CI: -0.09 to -0.01; P = 0.02). Moderate heterogeneity was observed for this outcome (I² = 58%). The pooled analysis of recurrence rates demonstrated a significantly lower risk of ERM recurrence in the Peel group compared to the No-Peel group (RR = 0.18; 95% CI: 0.07 to 0.48; P < 0.001). Heterogeneity for this outcome was low (I² = 15%). Quality assessment indicated a generally moderate to high quality across the included studies, though some concerns regarding blinding and allocation concealment were noted in certain studies. In conclusion, ILM peeling during vitrectomy for idiopathic ERM appears to be associated with a statistically significant, though modest, improvement in final BCVA and a substantially lower rate of ERM recurrence compared to no peeling. The clinical significance of the small BCVA improvement requires careful consideration against potential risks associated with peeling.
Tele-ophthalmology versus Traditional Fundus Photography for Diabetic Retinopathy Screening: A Comparative Meta-analysis of Diagnostic Accuracy, Cost-Effectiveness, and Health Policy Uptake Ramzi Amin; Dio Asgira Rizky
Community Medicine and Education Journal Vol. 5 No. 2 (2024): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v5i2.729

Abstract

Diabetic retinopathy (DR) remains a leading cause of preventable blindness globally, imposing a significant public health burden. Effective screening is paramount for early detection and timely intervention. Traditional fundus photography (TFP), often requiring specialized equipment and personnel, faces access challenges. Tele-ophthalmology (TO) has emerged as a potential solution to improve screening coverage. However, rigorous comparative evidence regarding its diagnostic accuracy relative to established TFP methods, its economic viability, and factors influencing its adoption into health policy and routine practice remains fragmented. This systematic review and meta-analysis aimed to synthesize the evidence comparing TO and TFP for DR screening across these critical domains. We conducted a systematic literature search adhering to PRISMA guidelines across PubMed, EMBASE, and Web of Science databases for studies published between January 1st, 2013, and December 31st, 2023. Keywords included "diabetic retinopathy," "screening," "teleophthalmology," "telemedicine," "fundus photography," "digital imaging," "diagnostic accuracy," "cost-effectiveness," and "policy." Inclusion criteria mandated studies directly comparing TO (any modality involving remote image grading) with TFP (in-person acquisition and grading or local grading) for detecting any DR or referable DR (RDR) in diabetic populations. Outcomes of interest were diagnostic accuracy (sensitivity, specificity), cost-effectiveness metrics (e.g., ICER), and reported health policy uptake or implementation factors. Study quality was assessed using adapted QUADAS-2 criteria for accuracy studies and relevant checklists for economic evaluations. 6 studies met the full inclusion criteria for this meta-analysis. Pooled sensitivity for detecting RDR using TO was 0.90 (95% CI: 0.87-0.93), compared to 0.92 (95% CI: 0.89-0.95) for TFP. Pooled specificity for TO was 0.91 (95% CI: 0.88-0.94) versus 0.93 (95% CI: 0.90-0.95) for TFP. Moderate heterogeneity was observed (I² > 50%). Health policy uptake varied significantly, influenced by factors such as established reimbursement frameworks, governmental support, integration with electronic health records, availability of trained non-ophthalmic personnel, and robust quality assurance protocols. In conclusion, tele-ophthalmology demonstrates high diagnostic accuracy for DR screening, comparable, albeit potentially slightly lower on average, to traditional fundus photography. Economic evaluations largely favor TO, suggesting significant potential for efficient resource allocation in DR screening programs. However, successful translation into widespread, effective public health policy requires addressing implementation barriers related to infrastructure, workforce training, reimbursement parity, and quality assurance.
Health System Factors Influencing the Adoption and Sustainability of Evidence-Based Retinal Care Guidelines: A Systematic Review and Meta-Synthesis Ramzi Amin; Rafika
Community Medicine and Education Journal Vol. 6 No. 1 (2025): Community Medicine and Education Journal
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/cmej.v6i1.730

Abstract

Evidence-based guidelines (EBGs) are crucial for optimizing care and outcomes for highly prevalent retinal diseases like diabetic retinopathy (DR), age-related macular degeneration (AMD), and retinopathy of prematurity (ROP). However, their translation into routine clinical practice remains inconsistent. Understanding the health system factors that facilitate or impede the adoption and long-term sustainability of these guidelines is critical for improving population eye health. This systematic review and meta-synthesis aimed to identify and synthesize qualitative evidence on health system-level determinants influencing the implementation of retinal care EBGs. We conducted a systematic review following PRISMA guidelines. Major biomedical databases (PubMed, Scopus, Embase, Web of Science) and grey literature sources were searched from January 2013 to December 2024 using keywords related to retinal diseases, guidelines, implementation, adoption, sustainability, and health systems. Inclusion criteria focused on qualitative or mixed-methods studies exploring factors influencing the uptake or continued use of formal retinal care guidelines within clinical settings. Two reviewers independently screened titles/abstracts and full texts, extracted data, and assessed study quality using the Critical Appraisal Skills Programme (CASP) Qualitative Checklist. A thematic synthesis approach, following Noblit and Hare's methodology for meta-ethnography, was employed to synthesize findings across studies, involving familiarization, coding, theme generation, and synthesizing translations between studies. 7 studies met the inclusion criteria. These studies originated from diverse healthcare systems and focused primarily on DR and AMD guidelines. Quality assessment indicated moderate to high methodological rigor across the included studies. The meta-synthesis identified six interconnected key themes representing health system factors influencing guideline adoption and sustainability: leadership engagement and organizational culture prioritizing evidence-based practice; resource allocation and infrastructure adequacy, including staffing, funding, and integrated IT systems; inter-professional collaboration and streamlined communication pathways across disciplines and care settings; alignment with external policy levers and financial incentives; perceived guideline characteristics and adaptability within local workflows; and robust feedback mechanisms and continuous quality improvement cycles integrated into the system. Lack of resources, fragmented communication, conflicting financial incentives, and inadequate leadership support emerged as primary barriers. In conclusion, the successful adoption and sustainability of evidence-based retinal care guidelines are profoundly influenced by a complex interplay of health system factors. Effective implementation requires more than guideline dissemination. Addressing these system-level determinants is paramount for bridging the evidence-practice gap and reducing preventable vision loss from retinal diseases globally. Policymakers and healthcare administrators must consider these multifaceted factors when designing and implementing strategies to enhance retinal care quality.
Co-Authors A.A. Ketut Agung Cahyawan W A.K Ansyori Ahmad Ghiffari Alfin Radhian Alfurqon Alfurqon Ammar Fardhana Ansyori, A.K. Ansyori, AK Ansyori, AK. Anwar, Chairil Ashita Hulwah A Ayu Aliyah Aziztama, Rezandi Budi Santoso Chairil Anwar Chairil Anwar Charil Anwar Cicilia, Monica Putri Cindy Kesty Defayudina Dafilianty Rosataria Devi Eryanti Devi Eryanti Dezca Nindita Dian Ariani Dian Puspita Sari Dina Fatwa Dio Asgira Rizky Dita Mintardi Dwiana Ocviyanti Dyah Rahayu Utami Elisa Taurisia Elza Iskandar, Elza Evasha, Agung Putra Faika Novadianaz Faiz Muhammad Ikhsan Faneisha Febrina Art Fensilia Yolanda, Gina Sonia Ferry Yusrizal Fidalia Galuh Ismayanti Ginda Chitra H. A. K. Ansyori H. A.K Ansyori Haloho, Agustina Br. Hamzah Hasyim Handayani, Retno Tharra Hartati Hartati Herdana, Nova Indiarsih, Tiara Bunga Indri Seta Septadina Irsan Saleh Kms Yusuf Effendi Krisna Murti Laksono Trisnantoro Linda Tri Wulandari M. Usman Salim Mandy Putriyudi Maria Ulfa Maya Ija Maya Sari, prima Mgs. Irsan Saleh, Mgs. Irsan Mistur Rozian Mufida Muzakkie Muhammad Baqir MUHAMMAD FAHMI Muhammad Irsan Saleh mulyati mulyati Mutiara, Ria Nailul Authoriyah Naufallah Dinda Harumi Nova Herdana Nur Farida Rahmawati Nyayu Fauziah Zen Oliffa Salma Atthahiroh Petty Purwanita Prima Maya Sari Purwanita, Purwanita Putra, Chani Sinaro Putri, Dwi Octaverina Radiyati Umi Partan Rafika Rafika Novianti Rahmah, Meidina Rajendra Ekki Maulana Reny Violeta Rika Anggraini Rika Anggraini Ririn Rahayu Ririn Rahayu MS Rizma Adlia Syakurah Roland Iqbal Rosataria, Defayudina Dafilianty Salim, Muhammad Usman Shaelva Lassa Sabatini Shariff, Muhammad Apriliandy Silvia Rahmi Siti Pradyta Phiskanugrah Sukmono, Nafila Mahida Syarif Husin Theodorus Tiara Mayasari Tribowo, Anang Vicela Patricia Virgyna Widya Wira Putri Yuanita Windusari Yuanita Windusari Zamzam, Avizena Muhammad Zen Hafy