A randomized controlled trial on the effect of Lutein Supplementation on Macular Pigment Optical Density and Macular Function in Pseudophakic Patients

Objective@#To evaluate the efficacy of oral lutein supplementation on macular pigment optical density (MPOD) levels and macular function in pseudophakic eyes that underwent phacoemulsification. @*Methods@#This was a prospective, randomized, parallel-arm, single-masked study comparing oral lutein supplement 20 mg/tablet (Lutax 20) with non-supplementation in pseudophakic eyes. We assessed MPOD, low-luminance deficit (LLD), visual recovery time (VRT) using photostress test, and adverse events. One hundred twenty-eight (128) eyes were enrolled and randomized 1:1 to active treatment (lutein supplementation) or no treatment (no supplementation). The supplementation period was 12 weeks and patients were assessed every 4 weeks over a period of 16 weeks.@*Results@#Sixty-four (64) eyes in each group completed the study. A significant increase in MPOD (p<0.001) was observed in the lutein supplemented group, from 0.36 DU at baseline to 0.55 DU at week 12, with a mean increase of 6.32 ± 1.72% per 4 weeks of supplementation compared with a mean MPOD decrease rate of 0.63 ± 0.48% in the non-supplementation group. A significant reduction in LLD was observed in the lutein-treated group, from LogMAR 0.063 at baseline to LogMAR 0.023 at Week 12 (p=0.003). VRT was also significantly shorter in the treatment from a baseline of 83.06 to 68.80 seconds at Week 12 (p<0.001).@*Conclusion@#Lutein supplementation (20 mg/tablet; Lutax 20) demonstrated a significant degree of MPOD augmentation, and reductions in LLD and VRT among patients who underwent phacoemulsification with lens implantation.

Knowledge, attitudes, and practices of telemedicine in Ophthalmology in a Tertiary Hospital: A cross-sectional survey

Objective@#The purposes of this study were to (1) describe the perceptions and practices of telemedicine among ophthalmologists in a tertiary hospital; and (2) evaluate knowledge, satisfaction, and perceived patient outcomes in using telemedicine to provide eye care in a time of a global pandemic.@*Methods@#This was a descriptive, cross-sectional study using a self-administered online survey. Thirty-two (32) ophthalmology consultants and residents-in-training in a single tertiary, private hospital who practiced telemedicine participated in this study. Descriptive statistics was used to summarize the data. Responses to open-ended questions were analyzed thematically@*Results@#The respondents were somewhat knowledgeable (75%) and somewhat confident (72%) in using telemedicine. Respondents strongly conveyed their satisfaction with telemedicine outcomes (56%). Majority also believed that their patients were satisfied with teleconsults (69%). Majority agreed that telemedicine can be effective for select types of care [i.e., chronic condition management (66%), follow- up care (62%), and acute non-emergency care (53%)]. Telemedicine also proved to be a boon during a pandemic due to its convenience (59%) and efficiency (63%). However, it is limited by the imperative need for face-to-face consults (69%) and technological constraints (44%).@*Conclusions@#Telemedicine was perceived to be a valuable solution during the present pandemic due to its convenience, safety, and ability to provide remote diagnosis and management of urgent and non-urgent cases. Although the current practice of telemedicine still has plenty of room for improvements in the standardization of training, connectivity and technological constraints, and addressing liability concerns, it can serve as an adjunct to face-to face consultations to provide optimal care for patients.

Association of cumulative dissipated energy and postoperative foveal thickness among patients with age-related cataract who underwent uncomplicated phacoemulsification

@#<p style="text-align: justify;"><strong>PURPOSE:</strong> Cumulative dissipated energy (CDE) is a phacoemulsification unit parameter designed to monitor the amount of energy delivered during phacoemulsification. Studies have already shown that lower CDE levels have better surgical outcomes, specifically in corneal recovery. However, few literature exists regarding the correlation between CDE and foveal thickness.</p> <p style="text-align: justify;"><strong>METHODS:</strong> In this prospective study, subjects with age-related cataract underwent cataract surgery by phacoemulsification. Central subfield thickness (CST), cube volume (CV), and cube average thickness (CAT) of the macula were measured by spectral-domain optical coherence tomography (OCT) at three separate time-points: preoperative, 1 day, and 14 days after cataract surgery. To determine the correlation between parameters, Pearson's correlation coefficients and degree of association, and coefficient of determination (r2 ) were used.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> One hundred eyes from 93 subjects were analysed. Preoperatively, mean CST was 247.71 ± 21.44 µm, CV was 9.38 ± 0.82 mm3 , and CAT was 262.94 ± 22.15 µm. At 12.42 + 11.05 of mean CDE exposure, the fovea increased in thickness in all measured parameters. The relationship between CDE and the change in foveal thickness values from baseline to postoperative Day 1 and Day 14 were examined. The correlation coefficients obtained for CST, CV, and CAT had low association to CDE. Furthermore, only the correlation coefficients of the difference between baseline and Day 1 of CST, and the difference between baseline and Day 14 observations of CV were significant (0.279 and -0.206, p=0.005 and p=0.040, respectively) but still with a low degree of association.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> There is a low, significant, direct association of the difference of CST on Day 1 from baseline with CDE, and a low, significant, indirect association of the difference of CV on Day 14 from baseline with CDE after routine phacoemulsification.</p>

Implementation and pilot data on diabetic retinopathy in a teleophthalmology program at a multispecialty primary care clinic

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To report on the implementation and initial pilot data of diabetic retinopathy (DR) identified using a validated telemedicine program for DR in a multispecialty primary care clinic.<br /><strong>METHODS:</strong> This was a retrospective, cross-sectional pilot survey of diabetic patients imaged for the first time at the telemedicine program of The Medical City from November 26, 2012 to August 31, 2013. The retinal images were obtained following the validated program of the Joslin Vision Network nonmydria. tic fundus photography for DR evaluation. These were evaluated by 4 retina specialists using a standardized protocol to assess for diabetic retinal disease and the presence of other retinal findings. The findings were recorded on customized electronic templates.<br /><strong>RESULTS:</strong> Seven hundred seventy-six (776) eyes of 388 patients were evaluated using the telemedicine program. The prevalence of DR was 28.2% (219 eyes), with 25.1% (195 eyes) having nonproliferative DR (NPDR). 14.2% 1110 eyes] had mild, 8.2% [64 eyes] moderate, 2.2% [17 eyes] severe, and 0.5% [4 eyes] very severe NPDR. 3.1% (24 eyes) had proliferative DR (PDR), of which 45.8% (11 eyes) had high-risk characteristics. The ungradable rate with selective mydriasis was 1.80% (14 eyes). The rate of referable DR (moderate NPDR or worse, any level of diabetic macular edema, or ungradable images) was 21.90% (170 eyes).<br /><strong>CONCLUSION:</strong> In the primary care setting, teleophthalmology can effectively identify patients with diabetic retinal complications and potentially refer these patients to appropriate levels of eye care. Retinopathy was present in over 28% of patients evaluated and over 21% had referable disease that may potentially progress to vision loss. Teleophthalmology for DR in this setting allows early detection of potentially sight threatening disease and may prevent visual loss and complications.</p>