Access to Pediatric Eye Care During a Pandemic: Systematic Review and Meta-Analysis.

Visual impairment affects many children and can lead to blindness if untreated. The coronavirus disease 2019 (COVID-19) pandemic has led to various restrictions and other challenges accessing in-person medical care, including essential pediatric eye care. The aim of this article was to determine and quantify the effect that pandemics have on access to pediatric eye care. A systematic literature search was conducted using various databases, which yielded 257 articles; nine were included in the final review. All included studies reported a decrease in the number of children accessing eye care during COVID-19. Most studies described virtual triage systems, which restricted in-person care to emergent cases. The average decrease in daily pediatric visits was 67.32% and reached statistical significance in the meta-analysis (P < .01). However, out of all patients with ocular complaints, the proportion of pediatric visits was unchanged, suggesting that the decrease in access to eye care was not specific to pediatric patients. [Pediatr Ann. 2023;52(2):e68-e75.].

Comparing the diagnostic accuracy of telemedicine utilization versus in-person clinical examination for retinopathy of prematurity in premature infants: a systematic review.

PURPOSE: To synthesize the literature assessing the diagnostic accuracy of telemedicine evaluation compared with clinical examination for retinopathy of prematurity (ROP) in premature infants. METHODS: Covidence software was used to conduct a systematic literature search from September 14, 2020, through September 27, 2020, on MEDLINE (Ovid), EMBASE (Ovid), CINAHL, and the gray literature to identify studies relevant to telemedicine utilization for ROP detection. After duplicate removal and two-levels of screening, studies comparing telemedicine evaluation with binocular indirect ophthalmoscopic examination were included. Risk of bias assessment was conducted for the included studies following data extraction. A qualitative review was performed to summarize estimates of accuracy of ROP evaluation by telemedicine. RESULTS: A total of 507 studies were reviewed, of which 323 were found in EMBASE, 115 in MEDLINE, and 79 in CINAHL. Three possibly relevant conference abstracts were found. Following duplicate removal, 410 studies were reviewed based on titles and abstracts. Subsequently, 19 articles were thoroughly examined, and 14 studies (2,655 participants) were included. Most studies found that telemedicine performance for detecting ROP was comparable to ophthalmic examination, especially with regard to identifying treatment-requiring ROP. CONCLUSIONS: Telemedicine evaluation can reliably detect ROP. Incorporation of telemedicine into conventional neonatal care has the potential to improve access to ROP care.

Repeat Selective Laser Trabeculoplasty for Glaucoma Patients: A Systematic Review and Meta-analysis.

AIM AND OBJECTIVE: To evaluate repeat selective laser trabeculoplasty (SLT) for treating primary open-angle glaucoma (POAG). MATERIALS AND METHODS: PubMed, CINAHL, and EMBASE were systematically searched along with grey literature. All English articles that measured intraocular pressure (IOP) before and after repeat SLT on adult patients with POAG were included. Studies were not filtered by location or publication date. Covidence was used to screen imported articles. Risk of bias assessment and data extraction was performed after screening. Meta-analysis was performed using STATA 16.0. Fixed-effect or random-effects models were developed depending on the presence of heterogeneity. RESULTS: Database and grey literature search identified 512 unique studies. After duplicate removal and screening, 12 articles were included and data from included studies were synthesized. Nine articles were included in the meta-analysis. Three studies were prospective observational studies, and nine studies were retrospective chart reviews. Due to the presence of heterogeneity, a random-effects model has been utilized that suggested significant IOP reduction (IOPR) by repeat SLT at 24 months follow-up. CONCLUSION: Based on our results, repeat SLT could be an effective procedure in reducing IOP for patients with glaucoma for up to 24 months. Efficacy of third, fourth, or further SLT remains to be verified. More data from long-term, high-quality randomized-controlled trials (RCTs) are required to make conclusions. CLINICAL SIGNIFICANCE: Repeat SLT may be an effective treatment for lowering IOP with minimal complications or safety issues. This may allow the use of SLT as a primary treatment for POGA, allowing the discontinuation of medications or eye drops and lead to additional benefits. HOW TO CITE THIS ARTICLE: Jang HJ, Yu B, Hodge W, et al. Repeat Selective Laser Trabeculoplasty for Glaucoma Patients: A Systematic Review and Meta-analysis. J Curr Glaucoma Pract 2021;15(3):117-124.

Quality of life of low vision patients: a systematic review and meta-analysis.

OBJECTIVE: Quality of vision plays an important role in everyday living, and low vision (LV) can take a toll on individual's quality of life (QOL). The objective of this paper is to evaluate the impact of LV on QOL and depressive symptoms in LV patients compared with healthy controls. DESIGN: Systematic review and meta-analysis. METHODS: Literature was systematically searched to obtain all relevant records. Covidence software was used to conduct the systematic review. Duplicate records were removed, and 2 independent reviewers screened records for relevance. After screening, risk of bias assessment was carried out. Data were extracted and meta-analysis was performed using STATA 15.0. Fixed-effect and random-effect models were computed based on heterogeneity. RESULTS: In total, 2870 records were retrieved from database and grey literature searches. Twelve articles (35 341 subjects) were included for quantitative analysis. Overall, the QOL of LV patients was significantly lower compared with healthy individuals. Common QOL questionnaires, including 25-item visual function questionnaire (VFQ-25) (standard mean difference [SMD] = 0.91, confidence interval [CI]: [0.42-1.40]), 36-item short form survey (SMD = 0.53, CI: [0.26-0.80]), VFQ-14 (SMD = 0.58, CI: [0.42-0.74]), and visual function QOL questionnaire (SMD = 0.68, CI: [0.54-0.82]), demonstrated a poor QOL in LV patients compared with healthy controls. Additionally, odds of depressive symptoms were significantly greater (odds ratio = 2.25, CI: [1.58-3.21]) in LV patients compared with controls. CONCLUSION: LV patients demonstrated a poor QOL and higher odds of depressive symptoms compared with healthy controls.

Diagnostic accuracy of current machine learning classifiers for age-related macular degeneration: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: The objective of this study was to systematically review and meta-analyze the diagnostic accuracy of current machine learning classifiers for age-related macular degeneration (AMD). Artificial intelligence diagnostic algorithms can automatically detect and diagnose AMD through training data from large sets of fundus or OCT images. The use of AI algorithms is a powerful tool, and it is a method of obtaining a cost-effective, simple, and fast diagnosis of AMD. METHODS: MEDLINE, EMBASE, CINAHL, and ProQuest Dissertations and Theses were searched systematically and thoroughly. Conferences held through Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Society of Ophthalmology were searched. Studies were screened using Covidence software and data on sensitivity, specificity and area under curve were extracted from the included studies. STATA 15.0 was used to conduct the meta-analysis. RESULTS: Our search strategy identified 307 records from online databases and 174 records from gray literature. Total of 13 records, 64,798 subjects (and 612,429 images), were used for the quantitative analysis. The pooled estimate for sensitivity was 0.918 [95% CI: 0.678, 0.98] and specificity was 0.888 [95% CI: 0.578, 0.98] for AMD screening using machine learning classifiers. The relative odds of a positive screen test in AMD cases were 89.74 [95% CI: 3.05-2641.59] times more likely than a negative screen test in non-AMD cases. The positive likelihood ratio was 8.22 [95% CI: 1.52-44.48] and the negative likelihood ratio was 0.09 [95% CI: 0.02-0.52]. CONCLUSION: The included studies show promising results for the diagnostic accuracy of the machine learning classifiers for AMD and its implementation in clinical settings.

The Prevalence of Occupational Burnout Among Ophthalmologists: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the prevalence of occupational burnout among ophthalmologists in order to better understand the mental and physical well-being of eye physicians and surgeons in the professional workplace. STUDY DESIGN: A systematic review and meta-analysis. METHODS: Online computer databases MEDLINE, EMBASE, CINAHL, and ProQuest Dissertations and Theses were searched systematically and thoroughly. Conferences held through Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, and Canadian Society of Ophthalmology were searched. Studies were screened using Covidence software. Data on reported burnout prevalence was extracted. STATA 15.0 was used to conduct meta-analysis.Synthesis: Our search strategy identified 318 records from online databases and 11 records from grey literature search, which were screened at 2-levels. Title and abstracts of each record were screened resulting in 24 records moving to full-text screening. Total of 9 records were utilized for quantitative analysis in the data extraction stage. Our results indicated significant professional burnout among ophthalmologists (ES = 0.41; CI: [0.26, 0.56]) with significant emotional exhaustion (ES = 0.43; CI: [0.33, 0.53]), depersonalization (ES = 0.29; CI: [0.13, 0.46]), and a low sense of personal accomplishment (ES = 0.36; CI: [0.08, 0.63]). CONCLUSIONS: Significant occupational burnout among ophthalmologists is concerning because burnout can have a negative effect on the physical and mental health of eye physicians and surgeons. It could impact productivity, cutbacks in work hours, or lead to early retirement from the profession. Contributing factors in ophthalmologist burnout including work overload need to be addressed in a timely manner.