Automated and ImageJ thresholding algorithm-based analysis of macular vessel density in diabetic patients

Purpose: To assess the macular vessel density (VD) on optical coherence tomography angiography (OCT?A) using proprietary software (automated) and image processing software (manual) in diabetic patients. Methods: In a retrospective study, OCT?A images (Triton, TOPCON Inc.) of type 2 diabetics presenting to a tertiary eye care center in North India between January 2018 and December 2019 with or without nonproliferative diabetic retinopathy (NPDR) and with no macular edema were analyzed. Macular images of size 3 × 3 mm were binarized with global thresholding algorithms (ImageJ software). Outcome measures were superficial capillary plexus VD (SCP?VD, automated and manual), deep capillary plexus VD (DCP?VD, manual), and correlation between automated and manual SCP?VD. Results: OCT?A images of 89 eyes (55 patients) were analyzed: no diabetic retinopathy (NoDR): 29 eyes, mild NPDR: 29 eyes, and moderate NPDR: 31 eyes. Automated SCP?VD did not differ between NoDR and mild NPDR (P = 0.69), but differed between NoDR and moderate NPDR (P = 0.014) and between mild and moderate NPDR (P = 0.033). Manual SCP?VD (Huang and Otsu methods) did not differ between the groups. Manual DCP?VD differed between NoDR and mild NPDR and between NoDR and moderate NPDR, but not between mild and moderate NPDR with both Huang (P = 0.024, 0.003, and 0.51, respectively) and Otsu (P = 0.021, 0.006, and 0.43, respectively) methods. Automated SCP?VD correlated moderately with manual SCP?VD using Huang method (r = 0.51, P < 0.001) with a mean difference of ?0.01% (agreement limits from ?6.60% to +6.57%). Conclusion: DCP?VD differs consistently between NoDR and NPDR with image processing, while SCP?VD shows variable results. Different thresholding algorithms provide different results, and there is a need to establish consensus on the most suited algorithm

Pattern of uveitis from a tertiary eye care center in Himalayan belt of North India

Purpose: To study the clinical characteristics of uveitis in patients presenting to a tertiary care institute in the northern part of India, predominantly serving the population of Himalayan belt. Methods: In this retrospective descriptive case series, data of 141 eyes of 102 patients diagnosed between January 2019 and January 2021 were analyzed. Patients were diagnosed, named, and meshed as per the Standardization of Uveitis Nomenclature. A panel of investigations (systemic and ocular ancillary investigations) were done, which was individualized according to the clinical picture. Results: The mean age of presentation was 39.1 ± 14.62 years. A male predominance (62.7%) was noted. Unilateral presentation was seen in 61.8% of patients. Specific etiological diagnosis was not reached in 56.7% of cases. The incidence of infectious and noninfectious uveitis was 23.4% and 19.9%, respectively. The frequency of anterior, intermediate, posterior, and panuveitis was 23.4%, 11.3%, 46.8%, and 18.5%, respectively. Posterior uveitis was the most frequent anatomical location (46.8%). Tuberculous uveitis was the most common definitive etiology irrespective of location (18.5%). Anterior, intermediate, and posterior uveitis were more frequently idiopathic in origin. Sympathetic ophthalmitis was the most common cause for panuveitis. Conclusion: Uveitis significantly affected the working age group population. Despite the evolution of diagnostic investigations, etiology remained unknown in many cases of uveitis. Infectious etiology was more common. Posterior uveitis as the most frequent anatomical location in our study may be attributed to the tertiary care referral bias.

Reducing Waiting-time of Preterm Babies at a Retinopathy of Prematurity Clinic: A Quality Improvement Project

Objective: To decrease the waiting time for preterm babiesvisiting the Retinopathy of prematurity clinic in a tertiary eyehospital.Design: Interventional study.Setting: Tertiary eye care hospital.Patients: All preterm babies reporting for screening and follow upat Retinopathy of prematurity clinic.Intervention/Procedure: A quality improvement teamcomprising of a faculty (team leader), two senior residents, twojunior residents, one nursing officer, and a registration staff wasconstituted.Fish bone analysis was done to understand variousreasons for the high waiting time for preterm babies. Baseline datawas collected followed by multiple Plan-Do-Study- Act (PDSA)cycles.Main outcome measures: Average waiting-time, maximumwaiting-time, and last baby entry-time were measured.Results: The median average waiting-time, maximum waiting-time and last baby entry-time at baseline were 90.5 min (range74.1 to 118.8 min), 177.5 min (range 160 to 190 min) and 111 min(90 to 118 min), respectively. At the end of 3rd PDSA cycle, thesereduced to 77.6 min (range 55.2 to 94.3 min), 122 min (range 110to 135 min), and 60 min (range 45 to 80 min), respectively andwere sustained; the decrease from baseline being 14.3%, 31.2%,and 46%, respectively.Conclusion: The time spent in the waiting area at theRetinopathy of Prematurity clinic was significantly reduced bysimple changes in the process flow.

Reducing Preoperative Waiting-time in a Pediatric Eye Operation Theater by Optimizing Process Flow: A Pilot Quality Improvement Project

Objective: To decrease the preoperative area waiting-time forchildren posted for eye surgery.Methods: A pilot quality improvement project was conducted in asingle paediatric eye operation theatre in our tertiary-carehospital. Operation theatre process flow was analyzed, baselinedata was collected, and two Plan-Do-Study-Act cycles wereperformed on consecutive days. Average and maximal waiting-time were recorded across six operation theatre days.Results: The average and maximal waiting time at baseline were221 and 390 minutes, respectively. After two rapid Plan-Do-Study-Act cycles, these were reduced to 29 (87% reduction) and 52minutes (87% reduction) from baseline, respectively, and couldsubsequently be sustained.Conclusion: Preoperative waiting time in ophthalmic operationtheatre was significantly reduced by simple process flowoptimization, thereby improving quality of care.

Asymmetric Presentation of Retinopathy of Prematurity

Retinopathy of prematurity (ROP) usually has symmetricpresentation and progression between fellow eyes. In thisretrospective review of records, asymmetric presentation wasnoted in 16 (3.9%) out of 410 babies over a period of one year.Management and final outcome differed in 10 and 11 infantsrespectively. ROP need not always be symmetric and may requirevariable management.