Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 85
Filter
1.
Clin Exp Optom ; : 1-5, 2022.
Article in English | PubMed | ID: covidwho-2151385

ABSTRACT

CLINICAL RELEVANCE: With the increasing use of technology and an emerging need for virtual clinical reviews, particularly following the recent pandemic, it is essential to evaluate the safety of these clinical tools. BACKGROUND: This retrospective study aims to determine the safety of virtual follow-up day one after cataract surgery. METHODS: All patients who underwent cataract surgery at Auckland District Health Board, New Zealand (Aotearoa), and were triaged for telephone review the day after surgery, from 5(th) November 2018 to 31(st) January 2020, were eligible. Outcomes measured: presentations to the acute eye clinic prior to the post-operative visit (number and reasons) and complications at the one-month follow-up (persistent inflammation, cystoid macular oedema, raised intra-ocular pressure). RESULTS: Nine hundred and eighty-seven cataract surgeries were triaged for virtual follow-up over the retrospective study period. Nine hundred and eighty-five cases in 928 patients met the inclusion criteria. The median duration of phone calls was 5 minutes (range 2-30). Prior to the one-month post-operative visit, there were 66 presentations to the acute eye clinic, most commonly due to ocular surface irritation (33.3%) and persisting inflammation (25.8%). At the one-month post-operative review, 110 cases (11.2%) had complications;62 (6.3%) had persisting inflammation, 46 (4.7%) had cystoid macular oedema, and two (0.2%) had raised intraocular pressure. CONCLUSIONS: This is the largest study of a virtual day one post-operative follow-up following cataract surgery, and demonstrates that, in carefully selected subjects, virtual follow-up is a safe alternative to a clinic review. This method could significantly reduce healthcare costs and serve to be more efficient and favourable for patients and clinicians.

2.
Clinical and Experimental Ophthalmology ; 50(8):971-972, 2022.
Article in English | EMBASE | ID: covidwho-2136738

ABSTRACT

Purpose: The eye surgeon's unique microsurgical skillset is developed over time from repeated and meticulous training on delicate ophthalmic tissue. The impact of COVID-19 on the delivery of regular ophthalmology services has impacted the exposure and available opportunities for skills development in the trainee. Adopting ophthalmic surgery teaching models and simulators as training resources provides solutions to enhance microsurgical skills of the trainee operating in a pandemic. Method(s): A literature search was performed to identify ophthalmic surgery skills training resources. We included prosthetic, harvested produce, non-live animal, and virtual reality and simulation devices. Human cadaveric models were excluded. Result(s): Several established and novel ophthalmic surgery training resources were identified. Low-cost prosthetic models and tissue substitutes are available to develop basic microsurgical and tissue handling skills. Harvested produce, non-live egg, porcine products, and sophisticated virtual reality devices imitate various aspects of ophthalmic tissue to allow simulation of ophthalmic surgery of varying complexity including cataract, corneal, glaucoma, vitreoretinal and strabismus surgeries. The use of ophthalmic skills training devices improved skills of trainee eye surgeons. Conclusion(s): A wide range of ophthalmic surgery training resources are available to both the individual trainee and the training organisation, and provide a wide range of accessible, evidenced solutions to augment surgical skill development not only during the pandemic but also beyond.

3.
Clinical and Experimental Ophthalmology ; 50(8):911, 2022.
Article in English | EMBASE | ID: covidwho-2136736

ABSTRACT

Purpose: Persisting inequity in access to eye care for Aboriginal and Torres Strait Islander Australians has been well documented. Over the past decade, a number of frameworks and initiatives have worked towards improving access to eye care, though inconsistent data reporting and availability makes it challenging to form a coherent overview of actual increases in access, and progress towards the population-based needs. The paper will present an improved understanding of access to cataract surgery for Aboriginal and Torres Strait Islander Australians. Method(s): Publicly available cataract surgical data over the past decade, including Medicare statistics, public hospital data, Australian Institute of Health and Welfare annual Indigenous Eye Health Measures reports, state health data, and past analyses in the literature, is combined and analysed to present an overview of existing surgical delivery and access and a more nuanced consideration of cataract surgery needs for Aboriginal and Torres Strait Islander Australians. Result(s): Large variance has been identified across jurisdictions, across public and private settings, and across remoteness levels, suggesting significant differences in access. The combined analysis highlights challenges in access for cataract surgeries in metropolitan areas. Finally, impacts of COVID-19 on service provision and the existing backlog is considered. Conclusion(s): Differing access rates provide an ongoing challenge to organised ophthalmology, as well as the wider eye care sector and national, state and territorylevel programs and policies. The shared goal is to best support increasing the cataract surgery rates for Aboriginal and Torres Strait Islander Australians to populationbased needs.

4.
Research and Practice in Thrombosis and Haemostasis Conference ; 6(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2128292

ABSTRACT

Background: Up to 23-25% of patients experience a second stroke within the first 5 years after the first episode despite prophylaxis. Aim(s): Our aim is to discuss the risk factors of recurrent ischemic stroke and the efficiency of anticoagulation therapy. Method(s): A report of a 50-year- old female patient who presented with a medical history of migraine, hypertension, 3 episodes of ischemic stroke within 12 years (the last one occurring 2 months ago), right hemiplegia, 2 miscarriages and multiple surgeries: appendectomy, myomectomy, hysterectomy due to adenomyosis, cataract surgery, cervical polypectomy, oophorectomy, meniscectomy after trauma. Result(s): Thrombophilia testing revealed heterozygous mutations of F13A1, ITGA2 and PAI1 genes. Antiphospholipid antibodies were within normal ranges. She received treatment with Rivaroxaban 20 mg/daily 1 month, B-Complex vitamins, after which Clopidogrel 75 mg was prescribed. But the next ischemic stroke with hemorrhagic transformation occurred within 6 months. Type 2 diabetes was diagnosed 1 year later and Metformin hydrochloride was initiated. She underwent cholecystectomy due to benign tumors of the gallbladder and received treatment for Helicobacter pylori after which fifth episode of ischemic stroke happened. One year later she complained of headache, dizziness, unsteady gait, memory impairment, syncope and convulsions. Electroencephalography and echocardiography findings were not remarkable, ultrasound revealed multinodular goiter (TIRADS 2). COVID-19 PCR test and anti-SARS- CoV- 2 IgG/IgM antibodies were negative. Labs showed 40.9% lymphocytes, prolonged APTT (45.4 s, reference range 30-40 s), slightly elevated ALT (34.9 U/L, reference range < 33). Urinalysis detected 0.03 g/L albumin and 1.13 HPF mucus. Two weeks later the sixth episode of ischemic stroke occurred despite receiving antiaggregation with Acetylsalicylic acid. Double testing for antiphospholipid antibodies, Protein C and S, homocysteine were normal, antithrombin III was 123.0%. Conclusion(s): Although low-risk thrombophilia mutations, type 2 diabetes, hypertension, overweight and multiple surgeries are the risk factors of 6 thrombotic events, cancer should be excluded taking into account her anamnesis.

5.
Expert Review of Ophthalmology. ; 2022.
Article in English | EMBASE | ID: covidwho-2114130

ABSTRACT

Objective: The objective of this study was to systematically review and meta-analyze the diagnostic accuracy of current machine learning classifiers for pediatric and adult cataracts. Method(s): 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. Result(s): Our search strategy identified 150 records from databases and 35 records from gray literature. Total of 21 records were used for the qualitative analysis and 11 records (100 134 images) were used for the quantitative analysis. In adult patients with cataracts, the pooled estimate for sensitivity was 0.948 [95% CI: 0.815-0.987] and specificity was 0.960 [95% CI: 0.924-0.980] for cataract screening using machine learning classifiers. For pediatric cataracts, the pooled estimate for sensitivity was 0.882 [95% CI: 0.696-0.960] and specificity was 0.891 [95% CI: 0.807-0.942]. Conclusion(s): The included studies show promising results for the diagnostic accuracy of the machine learning classifiers for cataracts and its potential implementation in clinical settings. Prospero registration: CRD42020219316. Copyright © 2022 Informa UK Limited, trading as Taylor & Francis Group.

6.
Community Eye Health Journal ; 35(114):11-11, 2022.
Article in English | GIM | ID: covidwho-2112066

ABSTRACT

Both current and new patients at Sankara Nethralaya Eye Hospital can use free community-based teleophthalmology services as well as paid online services, even if they do not have personal internet access. The first eye hospital in India to use teleophthalmology to offer primary eye treatment to patients in remote communities was Chennai's Sankara Nethralaya Eye Hospital in 2003. This free service provides thorough eye exams as well as screening for cataracts and diabetic retinopathy utilizing a satellite link put on the roof of a mobile eye care van. It quickly became apparent that more people not simply those in rural areas would need teleophthalmology services with the COVID-19 pandemic's arrival in 2020. The Indian government's practice guidelines for telemedicine, which it released at the start of the COVID-19 pandemic offered a framework for the control and expansion of teleconsultation services in the nation. Sankara Nethralaya set up three new teleophthalmology access points for new patients, current patients, and patients who do not have access to the internet but can visit an optical store in response to this and in addition to its current service in rural areas. A patient can consult an ophthalmologist directly from home using this paradigm, which uses not many resources. An electronic medical records system, teleconsultation capabilities (audio/video calling), and a payment portal are necessities for the hospital. After their eligibility has been verified at the hospital, clients who are unable to pay can receive free teleophthalmology services. Patients utilizing this model must have a smartphone and an internet connection (mobile internet or otherwise). Patients without smartphones are unable to share medical records or photographs, but they can still seek advise from doctors by making audio calls and sending short messages (SMS), as well as visiting an optical store that is affiliated with the hospital, if one is close. Teleconsultations are useful for pre-operative counseling, second opinions, evaluating uploaded patient records, and monitoring post-operative patients. Orthoptic, contact lens, poor vision, rehabilitation, and genetic counseling services can all be provided via teleconsultations. The quality management staff will be able to provide better services by gathering patient input after each teleconsultation and responding quickly to complaints.

7.
Int J Environ Res Public Health ; 19(22)2022 Nov 11.
Article in English | MEDLINE | ID: covidwho-2110093

ABSTRACT

The COVID-19 pandemic has disrupted routine hospital services globally. The cancellation of elective surgeries placed a psychological burden on patients. A questionnaire study was conducted to identify the psychological impact of canceling cataract operations on patients at Kowloon East Cataract Center, Tseung Kwan O Hospital, Hong Kong, from April to June 2020. In total, 99 participants aged 59 years old and above, who had their cataract surgeries postponed or as scheduled, were studied using the standardized patient health questionnaire (PHQ-9) and generalized anxiety disorder questionnaire (GAD-7). None of the patients who had their cataract surgeries rescheduled reached the cutoff score for major depression in PHQ-9, whereas, according to GAD-7, five patients had mild symptoms of anxiety, and one had severe symptoms. There was no significant psychosocial impact of the cancellation of cataract surgeries on patients.


Subject(s)
COVID-19 , Cataract , Depressive Disorder, Major , Humans , Middle Aged , COVID-19/epidemiology , Pandemics , Elective Surgical Procedures
8.
Indian J Ophthalmol ; 70(11): 3779-3784, 2022 11.
Article in English | MEDLINE | ID: covidwho-2100020

ABSTRACT

Cataract is the most common cause of avoidable blindness in the world. While cataract surgery is continually evolving, manual small-incision cataract surgery (MSICS) still remains highly relevant, especially with the threat of the coronavirus disease 2019 (COVID-19) still looming large over the world. MSICS today has a renewed significance, since it does not involve the use of any advanced machinery and relies mainly on easily sterilizable instruments, thereby making it a safe and inexpensive option. A self-sealing valvular tunnel entry forms the basis of MSICS, and proper positioning and construction of the tunnel is imperative to the success of the surgery. With more and more people demanding spectacle independence after surgery, it becomes important to have a thorough understanding of the factors that may influence surgically induced astigmatism in MSICS. These include the incision location, size and shape, configuration of the sclero-corneal tunnel, pre-existing ocular pathology, role of sutures, amongst others. With proper knowledge, many of these factors can be modulated to achieve best results.


Subject(s)
Astigmatism , COVID-19 , Cataract Extraction , Cataract , Surgical Wound , Humans , Astigmatism/diagnosis , Astigmatism/etiology , COVID-19/epidemiology , Cataract Extraction/adverse effects , Cataract Extraction/methods , Lens Implantation, Intraocular/methods , Cataract/complications , Surgical Wound/complications
9.
Am J Ophthalmol Case Rep ; 28: 101726, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2068628

ABSTRACT

Purpose: To report a case of presumed COVID-19 Pfizer third dose (booster) vaccination leading to severe panuveitis mimicking acute endophthalmitis in the early postoperative period following routine cataract extraction and intraocular lens implantation. Observations: A 68-year-old female with mild refractive error who previously received 2 doses of the BNT162b2 vaccine underwent routine cataract extraction and intraocular lens implantation in the right eye. On postoperative day (POD) 2 the patient received her BNT162b2 booster vaccination. On POD 3 the patient's vision was hand motion at face with photophobia. Anterior segment examination was significant for 2+ conjunctival injection, mild stromal edema, 4+ cell and flare with trace hypopyon, and 4+ anterior vitreous cell without any wound leak. Subsequent Gram staining, culture for aerobic and anaerobic bacteria, KOH preparation, and PCR testing for infectious organisms were also obtained, all of which were found to be negative. ESR and CRP values were also negative. The patient was started on intravitreal injections of vancomycin and ceftazidime, as well as oral moxifloxacin, fortified vancomycin and tobramycin drops, prednisolone acetate 1%, and atropine 1%. On POD 5 the patient reported significant improvement of her vision and was found to have 20/80 vision. On POD 12 her vision improved to 20/25, and improved further on POD 19 to 20/20 vision with a completely normal examination. Cultures remained negative throughout the entire course. Conclusions and importance: This is the first report to suggest a possible association between the BNT162b2 booster vaccination and development of acute panuveitis in the postoperative period after routine cataract extraction and intraocular lens implantation. This condition may mimic acute bacterial postoperative endophthalmitis and may portend a more favorable prognosis, but the authors believe such cases should nonetheless be treated aggressively as presumed infection.

10.
Investigative Ophthalmology and Visual Science ; 63(7):1381-A0077, 2022.
Article in English | EMBASE | ID: covidwho-2058693

ABSTRACT

Purpose : Age-related macular degeneration (AMD), diabetic retinopathy (DR), and glaucoma are vision-threatening diseases (VTDs) affecting 36 million people in the USA. With 5.7 ophthalmologists per 100,000 Americans, over 50% of VTDs go undetected. We assessed deep learning Artificial Intelligence (DLAI) in VTD detection in community and clinical settings. Methods : 223 subjects (mean age 54.6, 58% male) from community screenings (A) and clinic (B) underwent 45-degree retinal imaging. In A (non-dilated), an onsite telemedicine reader (R1) and remote ophthalmologist (R2) graded image quality (gamma and alignment, 1-5 scale) and referable VTD using the international grading scales for AMD and DR, and cup-to-disc ratio and nerve fiber layer for glaucoma. In B (dilated), gradings were collected from R1 and the clinical diagnosis (d). A senior ophthalmologist (R3) adjudicated disputed findings. In A, DLAI VTD referral was compared to R1/R2/R3 consensus (S);in B, overall referral was compared to R1/d/R3 consensus (C). Images were uploaded to a cloud-based DLAI (SELENA+, EyRIS Pte Ltd) (Fig 1). Cohen's kappa assessed intergrader agreement. Results : R1 and R2 found 4.7% eyes ungradable. DLAI marked 55.6% ungradable;74.6% of them were for AMD. Of the DLAI ungradable eyes, image quality was ≤ 3, and 56.2% had ≥ 1+ cataract (R1). Compared to in A, in B DLAI had higher sensitivity (97.1% vs. 63.2%) and positive predictive value (69.4% vs. 32%). In A, DLAI had higher specificity (94.5% vs.16.7%) and negative predictive value (98.4% vs. 75.0%) (Table 1). In A, Cohen's kappa was 0.946 between R1 and R2, with a 13% disagreement rate. In 56% of the disagreements, R3 agreed with R1. In B, Cohen's kappa was 0.874 for R1 and d;R1 referred more than d. In A and B, DLAI referred more than R1, R2, and H/C. DLAI referred all eyes with > 1 VTD (1%) for further examination. Grading times for DLAI, R1, and R2 were 30, 129, and 68 seconds. Conclusions : DLAI performed best in DR and glaucoma detection;a potential solution for the high ungradable rate can be for DLAI to re-center uploaded images. DLAI can increase efficiency and accessibility of screenings for multiple VTDs, in both underserved populations and clinic. The ability to minimize direct contact confers an advantage during COVID-19. Further studies will investigate DLAI use in VTD progression.

11.
Investigative Ophthalmology and Visual Science ; 63(7):1411-A0107, 2022.
Article in English | EMBASE | ID: covidwho-2058558

ABSTRACT

Purpose : Microincision vitrectomy surgery (MIVS) studies have shown low complication rates. In the setting of the COVID-19 pandemic and rural satellite clinics, we investigated the role of telemedicine as an alternative to postoperative visit (POV) regimens after uncomplicated MIVS. Methods : This IRB approved, prospective single-site, and single-surgeon study included patients without any history of glaucoma, ocular trauma, or severe systemic or ocular disease who underwent uncomplicated MIVS for any indication between January-August 2021. Prophylactic topical pressure-lowering drops were prescribed if POV intraocular pressure (IOP) was ≥22 mmHg. POVs included the same day after surgery, week(s) 1, 2, 8, and 12. Patients were randomly assigned (1:1) into two arms: telemedicine (TM) or In-person (IP). Weeks 1 and 8 POV utilized protocol-based and questionnaire guided undilated exams performed by an ophthalmology fellow that were conducted either TM or IP, according to arm assignment. Any patients with concerning symptoms identified at these visits were scheduled for dilated exams with the surgeon. All patients underwent dilated exams performed by the surgeon on the same day after surgery, weeks 2 and 12. Primary endpoint was mean best corrected visual acuity (BCVA). Secondary endpoints included changes in intraocular pressure (IOP), retinal nerve fiber layer thickness, and number of additional visits. Statistical analysis included Mann Whitney U and chi-square tests. Results : Fifty-two eyes from 50 patients (33 female, 17 male;p-value=0.02) with mean ages of 68.4±6.8 years underwent 55 total surgeries with 25 or 27G MIVS platforms. Forty-seven patients have completed all POVs. Mean preop BCVA logMAR was 0.53±0.55 and 0.40±0.45, and at 12 weeks, they were 0.39±0.45 and 0.26±0.33 for the TM and IP groups, respectively. No significant between-group differences were found for primary or secondary outcomes. All cases of abnormal IOP resolved by the following POV with pressure lowering drops. Concerning symptoms were identified in five patients requiring additional visits, revealing two cases of worsening macular edema (1 TM and 1 IP) and one case each of cataract progression (TM), vitreous hemorrhage (IP), and macular hole recurrence (TM). No complications presented at the TM or IP visits. Conclusions : Telemedicine-assisted POV regimens may be a safe and convenient alternative for patients undergoing uncomplicated MIVS.

12.
Investigative Ophthalmology and Visual Science ; 63(7):1379-A0075, 2022.
Article in English | EMBASE | ID: covidwho-2058539

ABSTRACT

Purpose : Vision Threatening Diseases (VTDs) (age-related macular degeneration, cataracts, diabetic retinopathy, glaucoma) affect 36 million individuals in the United States. 50% are unaware they have a VTD, disproportionally affecting minorities and lowincome groups with less access to eye care. While screening programs in underserved communities result in early detection, less than half of subjects with findings follow up with a specialist. This number is four times lower during COVID-19. Methods : Robotic Telepresence (RT) was implemented in this pilot study during COVID19 to increase real-time access to specialist care. 58 subjects (age 56, 45% male) underwent a non-mydriatic screening protocol over five screenings. They were divided into three groups for consult: In Person (IP) followed by RT (N = 21), RT followed by IP (N = 19), and IP only (N = 18). IP consult was done by an on-site certified reader. RT consult was done by an off-site glaucoma or retina specialist with access to blood pressure, visual acuity, intraocular pressure, 45° retinal images, and ocular coherence tomography Bscans via cloud-based software. Video connection for RT was established via HIPAAcompliant mobile hotspot. Subject demographics and preferences were collected afterwards via survey. Results : Of 40 RT consults, 26 were second opinion for VTD suspect and 14 were wellness encounters. 24 reported their last eye care visit >3 years ago or never. Following RT consult, 18 subjects received one or multiple VTD diagnosis and 3 with glaucoma were referred for pressure-lowering eye drops. In the group with IP consult first, preferences were 5% RT, 52% IP, and 43% none. In the group with RT consult first, preferences were 5% RT, 58% IP, and 37% none. There was no significant difference in number of questions asked, wait time, or encounter length between IP and RT consults. Conclusions : RT consults proved valuable in community-based VTD screenings, particularly during COVID-19 when access to eye care is further limited. Most subjects preferred IP. However subjects with VTD that face socioeconomic barriers benefit from immediate RT consult and management directives from remote subspecialists. Further studies should incorporate consults from additional specialties (endocrinologists, general practitioners, social workers) and include telehealth CPT code for reimbursement.

13.
Investigative Ophthalmology and Visual Science ; 63(7):265-A0119, 2022.
Article in English | EMBASE | ID: covidwho-2058538

ABSTRACT

Purpose : The COVID-19 pandemic has caused societal, behavioral changes that have resulted in increased near work and less outdoor time. These changes may influence myopia progression. We performed a retrospective, cross-sectional prevalence study on the population base in Olmsted County, Minnesota to determine if there are short-term changes in myopia. Methods : Individuals living in Olmsted County who received ophthalmic care at Mayo Clinic Rochester from 2018 to 2021 were analyzed. Exclusion criteria included 1) visually significant cataract, 2) pseudophakia, 3) prior refractive surgery and 4) Age < 6 years. Manifest refractions were converted to spherical equivalent (SE). Patients with a SE ≤ -0.5 D were classified as myopic while SE ≤ -6.0 D were classified with high myopia. Individual age, sex, visual acuity, and lens prescription data were recorded. An algorithm was designed to estimate prevalence for patients without a manifest refraction utilizing their visual acuity, as was used in the NHANES study . Results : We sampled 11,783 invidiual records (8,413 adults;3,370 children). In adults from 2018 to 2021, the prevalence of myopia was similar at 61% vs 59% (p=0.3887) and high myopia was also similar at 10% vs 9.9% (p=0.5447). In children from 2018 to 2021, the prevalence of both myopia was similar at 21% vs 17% (p=0.2) and high myopia was also similar at 2.6% and 3.8% (p=.37). Conclusions : From 2018 to 2021, we did not find any trends in myopia development over a relatively brief, 4-year window in either pediatric or adult patients living in Olmsted County, Minnesota.

14.
Investigative Ophthalmology and Visual Science ; 63(7):4100-F0064, 2022.
Article in English | EMBASE | ID: covidwho-2058436

ABSTRACT

Purpose : The COVID-19 pandemic has highlighted the need for telemedicine across all specialties. Though its utilization has increased since the start of the pandemic, ophthalmology has been reported to be among the specialties least likely to utilize telemedicine in practice. We evaluated the potential utility of portable slit lamp exam (SLE) videos and anterior segment photos as telemedicine modalities by comparing the findings from these modalities to those identified in-person in the clinic. Methods : Data was collected from 98 subjects at Rutgers Institute of Ophthalmology and Visual Science by non-ophthalmic trained staff, which included portable SLE videos and anterior segment photos, collected with Microclear digital hand-held slit lamp (Suzhou, China) and Canon non-mydriatic retinal camera CR-2 Plus AF (Tokyo, Japan), respectively. Analysis included anterior segment photos taken from 92 patients (183 eyes) and SLE videos taken from 91 patients (177 eyes), which were interpreted and compared to exam findings identified in-person in the clinic. Sample t-tests were used for statistical analysis. Results : Nuclear sclerotic cataract (NSC) had the most agreement between telemedicine interpretation and in-person exam (photo 93.8%, video 93.75%). Cortical cataract showed less agreement (photo 65.63%, video 45.16%) and posterior subcapsular cataract (PSC) showed the least agreement (photo 8.33%, video 0%) among cataract findings. Cornea findings were among those least likely to be identified (photo 12.5%, video 14.86%). Findings that showed statistically significant differences between photo and video included pinguecula (p=0.00032). PSC (p=0.044) and posterior capsule opacification (p=0.00098) showed statistically significant differences regarding identifying findings on telemedicine interpretation that were not documented in clinic. Conclusions : Portable SLE videos and anterior segment photos may have potential for utility as means of telemedicine, particularly for NSC. Portable SLE requires more training to display a full ophthalmic exam whereas photographs can easily be done by non-ophthalmic trained staff, displaying similar findings. Differences in exam findings may be attributed to lack of documentation when patients present to the clinic for more urgent concerns and lack of focus on slit lamp videos by non-ophthalmic trained staff. (Figure Presented).

15.
Investigative Ophthalmology and Visual Science ; 63(7):2814-A0144, 2022.
Article in English | EMBASE | ID: covidwho-2058434

ABSTRACT

Purpose : The COVID-19 pandemic led to unprecedented cancellation or alteration of healthcare events and medical conferences around the world. Many ophthalmology conferences transitioned to virtual interfaces, and the impact of this transition on the ophthalmology community is unclear. The authors wish to objectively define the impact of the COVID-19 pandemic on subspecialty ophthalmology conferences. Methods : This study included data from the following five ophthalmology conferences from 2019, 2020, and 2021, as available: American Glaucoma Society (AGS), American Society of Ophthalmic and Plastic Reconstructive Surgery (ASOPRS), American Society of Cataract and Refractive Surgery (ASCRS), North American Neuro-Ophthalmology Society (NANOS), and Women in Ophthalmology (WIO). Data requested from organizations included the following, as available: Number of total conference attendees, number of attendees stratified by level of training, number of attendees stratified by identified gender, and number of research s or presentations (submitted and/or accepted). This study has been approved by the City University of New York Institutional Review Board. Results : In our study, 60% of organizations demonstrated an increase in number of attendees when using a virtual interface compared to their in-person events. 80% of organizations demonstrated a marked increase in attendance by trainees on their virtual interfaces. 60% of organizations displayed a decrease in number of submitted s when using a virtual interface. 40% of organizations experienced an increase in number of accepted posters and presentations through a virtual platform. Conclusions : Virtual conference interfaces have the potential to increase overall attendance and research participation within the ophthalmology community. Organizations should consider a hybrid model that incorporates aspects of both virtual and in-person interfaces to potentially maximize attendance, outreach, dissemination of information, opportunity, and minimize costs.

16.
Investigative Ophthalmology and Visual Science ; 63(7):453, 2022.
Article in English | EMBASE | ID: covidwho-2058398

ABSTRACT

Purpose : Autosomal recessive CEP290-LCA (LCA10) is a severe inherited retinal disease resulting in early vision loss and currently has no treatment. Sepofarsen is an RNA antisense oligonucleotide targeting the most common c.2991+1655A>G disease-causing variant in the CEP290 gene. Long-term safety and efficacy of sepofarsen in the first eye treated (FE) and safety and efficacy in the second eye treated (SE) in this extension trial (Insight;NCT03913130) were evaluated. Methods : Subjects who completed the Ph1b/2 sepofarsen trial could enroll in the extension trial for continued dosing in the FE and initiation in the SE with the 160/80μg loading/maintenance dose. Frequency and severity of adverse events, and change in best-corrected visual acuity (BCVA) and full-field stimulus testing (FST) threshold were assessed. Baseline was defined as the value measured within the same month of-or last measurement prior to-the first dosing for each eye. Due to covid-19, some participants have missed scheduled injections. As such data up to-or available measurement prior to-6 months after the last dosing have been included in the analysis for each eye. Results : At data cut-off in mid-October 2021, 9 subjects (of 11 from the Ph1b/2 trial) aged 15-45 years were followed up to 46 months, 5 of them received at least one intravitreal injection of sepofarsen in the SE. Three subjects developed cataracts in the FE and 2 in the SE, of which 2 recovered following cataract surgery. Time to onset since initial dose was 13 months or later. Between 35-46 months after the 1 injection, long term BCVA improvement was reported in 4/6 FE ranging from-0.20 to-0.54 logMAR and 5/5 FE improved in either blue FST, red FST or both ranging from-0.21 to-2.06 log cd/m2. The SE showed a similar trend as the FE in BCVA (3/5 SE showed a change ranging from-0.06 to-2.50 logMAR) and in blue and red FST (4/4 SE showed improvement ranging from-0.27 to-4.57 log cd/m2). st Conclusions : The longer-term sepofarsen safety profile is consistent with that observed in the Ph1b/2. Meaningful BCVA and FST improvements observed in the Ph1b/2 continued up to 46 months. The responses in the SE were similar to the responses seen in the FE in both visual acuity and retinal sensitivity improvements. A Phase 2/3 (ILLUMINATE;NCT03913143), multiple dose, double-masked, randomized, sham-controlled trial is ongoing.

17.
Investigative Ophthalmology and Visual Science ; 63(7):1412-A0108, 2022.
Article in English | EMBASE | ID: covidwho-2058348

ABSTRACT

Purpose : The COVID-19 pandemic has accelerated the introduction and dissemination of telemedicine into ophthalmic secondary care. Yet this pivot to telemedicine-dominated care could exacerbate the differential in health outcomes for certain groups. This study seeks to quantify and characterise factors associated with non-attendance within a population of patients attending synchronous tele-ophthalmic hospital outpatient appointments. Methods : A retrospective cohort study at a tertiary-level ophthalmic institution comprising a principal central site, four district hubs and five satellite clinics in London, UK between January 1st 2019 and October 31st 2021. Multivariable logistic regression modeled attendance status against sociodemographic, clinical and operational exposure variables for all new patient registrations. Results : Between January 1st 2019 and October 31st 2021, a total of 6843 eligible patients (mean age of 45 +/- 32, 58.0% female) were newly registered to attend synchronous teleophthalmology clinics. Self-reported ethnicity identified 3.4% as South Asian, 1.4% Black, 25.3% Other Ethnic Group and 7.6% White. 62.3% did not report their ethnicity. Most appointments were in general ophthalmology (59.9%, n=4096), followed by cataract (20.2%, n=1379), adnexal (19.1%, n=1310), medica retina (0.1%,n=55) and glaucoma (0.0%,n=3). Increased rates of non-attendance were associated with male sex (adjusted OR 0.74, CI 0.62-0.88), greater levels of deprivation (adjusted OR 0.88, CI 0.84-0.92), incompletion of self-reported ethnicity (adjusted odds ratio 0.3, CI 0.17-0.54) and a previously cancelled appointment (adjusted OR 0.65, CI 0.5-0.83) (all p<0.001). Individuals identifying as Asian or Black ethnicity had worse attendance in synchronous clinics with adjusted odds ratios of 0.42 (CI 0.20-0.90, p = 0.02) and 0.28 (CI 0.12-0.65, p=0.0025) respectively. Patients with diabetes were more likely to attend with an adjusted odds ratio of 1.03 (CI 0.3-3.55, p = 0.9). Conclusions : With regards to synchronous teleophthalmology clinics, poorer attendance is associated with male sex, greater socioeconomic deprivation and self-reported Asian and Black ethnicities. Further study is warranted to evaluate whether enhanced surveillance of these cohorts could improve their non-attendance rates.

18.
Investigative Ophthalmology and Visual Science ; 63(7):2155-A0183, 2022.
Article in English | EMBASE | ID: covidwho-2058317

ABSTRACT

Purpose : The effect of coronavirus disease 2019 (COVID-19) on ophthalmic surgical case numbers in Australia and globally remains poorly characterised. Increased incidence of COVID-19 in Australia between March and April 2020 led to a national lockdown and elective surgery restrictions. The aim of this population-based study was to quantify the early impact of COVID-19 on ophthalmic surgery in Australia, comparing surgical service rates in 2019 and 2020. Methods : Retrospective analysis of the number of ophthalmic surgical services in 2019 and 2020 in all Australian States and Territories, as recorded by Medicare (Australian Government-funded universal health insurance scheme subsidising healthcare costs for Australian residents). Monthly surgical service rates were calculated and Poisson regression was used to compare the change in service rates between months. Results : Between March and April 2020, surgical service rates decreased for: cataract surgery (by 71%, 95% CI: 70-72%), cataract surgery with minimally invasive glaucoma surgical device insertion (by 71%, 95% CI: 65-75%), pterygium removal (by 67%, 95% CI: 60- 72%), corneal transplantation (by 31%, 95% CI: 9-48%), and collagen crosslinking for corneal ectasias (by 35%, 95% CI: 18-48%). Comparatively, service rates for these surgeries did not differ or decreased less between March and April 2019. Interestingly, glaucoma filtration surgery rates decreased between March and April in 2020 (by 44%, 95% CI: 29- 56%) and also in 2019 (by 45%, 95% CI: 31-55%), whilst retinal detachment surgery rates were unchanged between these months in 2020 (crude decrease 9%, 95% CI: -28 to 16%) and 2019 (crude decrease 11%, 95% CI: -26 to 9%). Conclusions : Despite relatively low rates of COVID-19 community transmission in Australia in 2020, ophthalmic surgical service rates decreased during months in lockdown and with restrictions, largely for non-time-critical conditions. These data may have health planning implications as the pandemic continues, with future lockdowns and restrictions possible, especially as COVID-19 variants emerge.

19.
Investigative Ophthalmology and Visual Science ; 63(7):2139-A0167, 2022.
Article in English | EMBASE | ID: covidwho-2058118

ABSTRACT

Purpose : Pandemic era restrictions on non-essential travel, redistribution of healthcare resources, and nursing shortages have impacted the ability of ophthalmologists to deliver care. California had among the strictest 2020 restrictions during the pandemic with reallocation of non-essential surgical resources. This study assesses changes in surgical volume of common ophthalmic procedures in California since the COVID-pandemic. Methods : The California Health and Human Services Agency (Office of Statewide Health Planning & Development) maintains ambulatory and emergency room procedural databases. Common ophthalmic procedures and surgical volumes were extracted for 29 CPT codes from 2014-2020. Procedures with fewer than 100 cases were excluded. Results : Overall, ophthalmology surgical volume decreased by 19% from 2019 to 2020. Greatest declines were for anterior lamellar corneal transplant (39%) and pterygium with graft (38%). Simple cataract surgeries declined by 29% in 2020, compared to an average annual decline of 3% from 2014-2019. Volume increased only for two surgeries: aqueous shunt with graft (2%) and complex retinal detachment (0.2%). Temporal artery biopsies, historically stable with 0.2% average change from 2014-2019, declined by 28% in 2020. Retinal detachment repairs declined by 20% and 17% (with and without vitrectomy, respectively). In comparison, laparoscopic appendectomy only declined by 2% in 2020. Limitations of this study include role of population changes and changes in annual coding practices. Conclusions : COVID era declines were noted across almost all ophthalmic surgeries with steep drops in perceived non-urgent procedures such as pterygium and cataract. However, delays in cataracts and other conditions can result in increased disease burden and morbidity for patients. Uniquely, tube shunt procedures increased, perhaps due to progression of glaucoma from delayed routine care. For vision-preserving surgeries such as retinal detachment repair, lack of accessible care during the pandemic is especially concerning.

20.
Investigative Ophthalmology and Visual Science ; 63(7):2789-A0119, 2022.
Article in English | EMBASE | ID: covidwho-2057981

ABSTRACT

Purpose : Health systems' responses to the coronavirus disease 2019 (COVID-19) pandemic created a surgical backlog of unknown size, limiting the ability to develop strategies to effectively address the backlog. We assessed the volume of deferred ophthalmic surgeries associated with the COVID-19 pandemic from March-December 2020 and suggested strategies and duration to clear the backlog in Ontario, Canada. Methods : Ontario Health Insurance Plan physician billing data from 2017-2020 were analyzed. The ophthalmic surgical backlog associated with the pandemic was estimated using time series forecasting models on training set (115 weeks), validation set (52 weeks) and forecasting set (42 weeks). Clearance time was calculated based on the queuing theory using various scenarios. Results : In 2020, there were 5.13 million ophthalmologist services, a reduction of 22% compared to the 6.60 million services in 2019. This included a 27% decrease in ophthalmic surgeries that require the use of operating rooms (OR) and a 6% decrease in anti-VEGF (vascular endothelial growth factor) injections (a common procedure for macular degeneration) that can be done in clinics. From March 16 to December 31, 2020 (a pandemic period), the estimated backlog in ophthalmic surgeries requiring an OR was 92,150 surgeries (95% prediction interval [PI] 71,288-112,841), increasing on average by 2,194 surgeries per week. Roughly 90% of the delayed surgeries were cataract surgeries and 4% were retinal detachment surgeries. Nearly half of the provincial backlog (48%, 44,542/92,150) involved patients from the West health region. Estimated provincial clearance time was 248 weeks (95% confidence interval [CI] 235-260) and 128 weeks (95% CI 121-134) if 10% and 20% of OR surgical capacity per week were added, respectively, based on the weekly ophthalmic surgical volume in 2019. Furthermore, an estimated 23,755 (95% PI 14,656-32,497) anti-VEGF injections were missed. Conclusions : The magnitude of ophthalmic surgical backlog in Ontario in 2020 alone raises serious concerns for meeting the ophthalmic surgical needs of patients. As the pandemic continues the accrued backlog size is likely increasing. Planning and actions are needed urgently to manage the collateral impact of the pandemic on the ophthalmic surgical backlog in Ontario.

SELECTION OF CITATIONS
SEARCH DETAIL