Reading Speed Using the International Reading Speed Texts in a Normal Canadian Cohort.

Background The International Reading Speed Texts (IReST) are commonly used to measure reading speed, which may be affected in many eye conditions. They were originally tested in a younger British population. Our study evaluates IReST in a normal Canadian population. Methodology A normal Canadian cohort in Ontario was prospectively recruited with age >14 years, education >9 years, English as the primary language, and best-corrected visual acuity >20/25 distance and >N8 near in each eye. Participants with eye conditions and neurological/cognitive problems were excluded. Each participant consecutively read two IReST passages (passages 1 and 8). Reading speed in words per minute (WPM) was calculated. One-sample t-test was used to compare our cohort to published IReST standards. Results A total of 112 participants were included (35 male, 77 female). The mean age was 40 ± 17 years (14-18 years: 12; 18-35 years: 34; 35-60 years: 53; 60-75 years: 13). The mean reading speed for passage 1 was 211 ± 33 WPM compared to the published IReST standard of 236 ± 29 WPM (p < 0.0001). The mean reading speed for passage 8 was 218 ± 34 WPM compared to the IReST standard of 237 ± 24 WPM (p < 0.0001). Thus, our cohort read slower for both passages compared to IReST standards. The mean reading speed for passages 1 and 8 was the highest for the 14-18-year (231 and 239, respectively) and the lowest for the 60-75-year group (195 and 192, respectively). Conclusions Normal older populations have slower reading compared to younger populations. The slower reading in our cohort may also be because the passages were in British rather than in Canadian English. It is important that the IReST is evaluated in different populations to ensure reliable comparison standards for future research.

A Systematic Review of Economic Evaluations Conducted for Interventions to Screen, Treat, and Manage Retinopathy of Prematurity (ROP) in the United States, United Kingdom, and Canada.

PURPOSE: A systematic literature review (SLR) of economic evaluations (EE) conducted for interventions to screen, treat, and manage retinopathy of prematurity (ROP) in the United States (US), United Kingdom (UK), and Canada was performed. METHODS: The SLR accessed the MEDLINE, Embase, Cochrane, Web of Science, Health Business Elite, Econ. Lit, NHS EED, and Google Scholar databases over the period 1st January 2000 to 4th August 2021. The key Medical Subject Heading (MeSH) search terms used included: Retinopathy of prematurity, Cost-effectiveness analysis, Cost-utility analysis, Cost of illness, Cost-benefit analysis, Cost minimization analysis, Incremental cost-effectiveness ratio, Quality adjusted life years, return on investment, burden of illness, disability adjusted life years, and Economic evaluation. Screening was conducted using Covidence, and the risk of bias was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Data extraction was performed using MS Excel. RESULTS: 1,527 articles were examined with nine (9) papers identified, one (1) from the UK; two (2) from Canada and six (6) from the US. Cost-effectiveness analysis was the main form of EE conducted (n = 5) and telemedicine screening (n = 3) was found to be highly cost-effective for ROP with the ICER values ranging from £446 to £4,240 per Quality Adjusted Life Year (QALY) in 2021 figures. 73% of included studies complied with the CHEERS checklist for EE. CONCLUSIONS: ROP screening and treatment strategies reviewed were highly cost-effective. This review may assist eye health policymakers in planning nationwide screening and treatment programs to combat vision loss and blindness due to ROP.

Comparative Analysis of Axial Length Measurements by Optical Biometers Based on Partial Coherence Interferometry Versus Optical Low-Coherence Interferometry: An Office Audit.

Purpose In this study, we aimed to compare axial length (AL) measurements of the IOLMaster 500 (Carl Zeiss Meditec AG, Jena, Germany), based on partial coherence interferometry (PCI) versus the Aladdin (Topcon Healthcare, Oakland, NJ), based on optical low-coherence interferometry (OLCI), in a clinical setting. Methods A retrospective analysis of the records of patients presenting for cataract surgery at an ophthalmology practice between October 2019 and March 2020 was performed. All patients had biometry measurements on the IOLMaster 500 and the Aladdin. Data collected included patient demographics, cataract morphology and type, and AL measurements. The IOLMaster 500 and Aladdin measurements were compared using the unpaired t-test and Chi-squared test. Results In total, 393 eyes (197 patients) were included (91 males, 107 females) in the study. The IOLMaster 500 was unable to successfully obtain AL measurements in seven eyes (1.8%) and the Aladdin in 26 eyes (6.6%). The difference was statistically significant (p=0.0007). Advanced and central posterior subcapsular cataracts were common in eyes that had unsuccessful measurements. In the eyes successfully measured, the mean AL for the IOLMaster was 24.04 ±1.32 mm, while it was 24.04 ±1.34 mm for the Aladdin. However, this difference was not statistically significant (p=0.9165). Conclusion The IOLMaster 500 performed better in terms of the number of eyes for which AL measurements were successfully obtained compared to the Aladdin. This may be partly related to high volumes of advanced cataracts treated at our practice. However, this being a retrospective study, a cause-and-effect relationship could not be established.

Immediate versus delayed sequential bilateral cataract surgery in children: a cost-effectiveness analysis.

BACKGROUND/AIMS: Children with bilateral cataracts may undergo immediate sequential bilateral cataract surgery (ISBCS), which involves surgery on both eyes during the same general anaesthesia, or delayed sequential bilateral cataract surgery (DSBCS), which involves operating on each eye on separate days and requires a second anaesthesia. ISBCS is viewed with caution because of the risk of bilateral endophthalmitis. Proponents of ISBCS emphasise that the incidence of serious complications is low and is outweighed by benefits such as avoidance of multiple anaesthesia, faster visual rehabilitation and potential for decreased costs. However, there is a paucity of literature regarding the cost-effectiveness of ISBCS in children. We conducted a cost-effectiveness analysis to determine whether ISBCS is more cost-effective than DSBCS from the societal and health system perspectives in Ontario, Canada, which has a universal, single-payer system. METHODS: A retrospective analysis of children who underwent ISBCS or DSBCS at a tertiary referral paediatric hospital was conducted. A decision tree was constructed using TreeAge Pro 2018 software. Clear visual axis was the measure of effectiveness. A time horizon of 8 weeks postoperatively was adopted. Both direct and indirect costs were included. RESULTS: Fifty-three children were included, 37 in the ISBCS group and 16 in the DSBCS group. ISBCS and DSBCS were equally effective. ISBCS resulted in cost-savings of $3,776 (95% CI:-$4,641 to $12,578) CAD, per patient, from the societal perspective and $2,200 (95% CI:-$5,615 to $10,373) CAD per patient from the health system perspective. CONCLUSION: ISBCS was less costly than DSBCS from both societal and health system perspectives while being equally effective.

Applications of iodine-125 plaque radiotherapy for residual or recurrent retinoblastoma.

OBJECTIVE: To determine the role of iodine-125 plaque radiotherapy (IPR) as a secondary treatment for localized (solitary or multiple) residual (partially regressed) or recurrent (regrowth after ≥6 months stability) retinoblastoma in the era of systemic and/or regional chemotherapy. DESIGN: A single-institute retrospective, noncomparative, interventional case series managed between July 2014 and June 2019. PARTICIPANTS: Thirteen consecutive eyes of 12 patients with 14 residual or recurrent retinoblastoma tumors treated with IPR. Patients who had to follow up <1 year post-IPR were excluded except for those who had enucleation. METHODS: Data collected included pre-IPR treatments, tumor characteristics at IPR, and post-IPR anatomical outcome (local tumor control and globe salvage) and functional outcome (radiation complications). RESULTS: Local tumor control was achievable in 12 of 14 tumors. Local recurrences were observed in 2 of 5 tumors that exhibited fish-flesh regression after IPR (p = 0.04). Globe salvage was possible in 11 eyes (12 tumors). Only 2 eyes were legally blind and the remaining 9 eyes had vision >20/125. Radiation-induced complications included radiation retinopathy (4/11), radiation papillopathy (1/11), diffuse vitreous hemorrhage (4/11). Eyes with fish-flesh-regressed tumours tended to show more complications, but were statistically insignificant (p = 0.09, Fisher exact test). There was no association of time to IPR (early <6 months vs late >6 months) with occurrence of tumor recurrence or complications (p > 0.05). CONCLUSION: IPR offers satisfactory local tumor control and globe salvage in localized recurrent/residual retinoblastoma. Fish-flesh tumor regression after IPR should be closely monitored for further recurrences.

Outcomes and complications of immediate versus delayed sequential bilateral cataract surgery in children.

PURPOSE: To present the largest series to date comparing outcomes and complications of immediate versus delayed sequential bilateral cataract surgery (ISBCS vs DSBCS) in children at a single center over a 10-year period. METHODS: The medical records of children <2 years of age who underwent ISBCS and DSBCS were reviewed retrospectively. Data was collected on outcomes and complications (ophthalmological and anesthesia-related) up to 8 weeks postoperatively. RESULTS: A total of 53 children were included: 37 ISBCS and 16 DSBCS. There were no differences between groups with regard to sex, age at surgery, and type of surgery. The ISBCS group had significantly more patients with systemic or ocular comorbidities than the DSBCS group (35% vs 6%; P = 0.029). Mean operating room time was significantly lower for the ISBCS group (3.61 vs 4.09 hours; P = 0.037), whereas total surgical time was similar. No major intraoperative surgical complications or anesthesia-related adverse events occurred in either group. Postoperative complications (most commonly, raised intraocular pressure) occurred in 5 eyes (7%) in the ISBCS group and 8 eyes (25%) in the DSBCS group (P = 0.009). Patients in the ISBCS group required significantly fewer follow-up visits compared to the DSBCS group (4 vs 6; P = 0.0002). CONCLUSIONS: ISBCS avoids multiple anesthesia sessions and reduces follow-up visits, with intra- and postoperative ophthalmological or anesthesia-related complications comparable to DSBCS.

Informed consent for strabismus surgery: the importance of patient information sheets.

PURPOSE: To analyze the additive effect of supplementing verbal consent with written patient information sheets in optimizing patients' and families' understanding of strabismus surgery. METHODS: A prospective randomized study was conducted with 28 patients for strabismus surgery randomized into two groups: group 1 with standardized oral informed consent, and group 2 with standardized oral consent and a written information sheet. A confidential questionnaire with 13 questions was completed by patients and families before surgery. RESULTS: A total of 7 adults and 21 children were included in the study. The mean score (number of correct answers) for group 1 was 4.14 ± 1.99; for group 2, 5.79 ± 2.12 (P = 0.044), indicating that patients and families in group 2 understood their strabismus surgery better than those in group 1. Areas needing more emphasis during the consent process were identified, including risk of under- or overcorrection or repeat surgery and use of eyedrops postoperatively. CONCLUSIONS: In this study, patient information sheets seemed to help patients and families better understand information about their surgery. Patient recall of information provided is poorly reliable and must be considered in decision making for medicolegal cases.

Bilateral superior rectus transposition and medial rectus recession for bilateral sixth nerve palsy.

PURPOSE: To present the results of bilateral superior rectus transposition with medial rectus recession in a case of chronic bilateral sixth nerve palsy. OBSERVATION: Bilateral superior rectus transposition with medial rectus recession resulted in full correction of esotropia with resolution of horizontal diplopia, improvement in abduction, and regain of stereoacuity in our case. There was minimal limitation of adduction, with no abnormal vertical or torsional changes. CONCLUSION AND IMPORTANCE: Bilateral superior rectus transposition with medial rectus recession appears to be a useful procedure for surgical treatment of bilateral sixth nerve palsy with minimal side effects. Given its potential for reduced risk of anterior segment ischemia (ASI), it may have especially good value in the select group of patients at risk for ASI. Studies with larger sample size and longer follow up are needed to further evaluate this procedure and elucidate the variables in surgical technique for superior rectus transposition.

Foveal neovascularization in a patient with Type 2 diabetes mellitus.

Retinal neovascularization in Diabetes mellitus (DM) is commonly seen at the optic disc and mid-periphery. It is rare at the fovea as the fovea is an avascular zone and there are very few case reports of foveal neovascularization in Type 1 DM. We report a case of unilateral foveal neovascularization in Type 2 DM.

Massive Retinal Pigment Epithelial Detachment Following Acute Hypokalemic Quadriparesis in Dengue Fever.

PURPOSE: To describe an unusual retinal manifestation of dengue fever in an endemic region. CASE REPORT: A 35 year old male presenting with acute onset decreased vision in his right eye, was found to have a massive retinal pigment epithelial detachment (PED) extending up to the vascular arcades. He had been diagnosed with acute hypokalemic quadriparesis in dengue fever in the preceding week, which had resolved following treatment. The patient was managed conservatively. At three months follow up, there was spontaneous flattening of the PEDs with improvement in visual acuity. CONCLUSION: Dengue fever complicated by acute hypokalemic quadriparesis can be associated with PED, which can be large. The condition resolves spontaneously and bears a good prognosis.

Congenital third nerve palsy with synergistic depression on attempted adduction and trigemino-oculomotor synkinesis: Underpinnings of a spectral dysinnervation disorder.

The authors describe a case of congenital partial pupil-sparing third cranial nerve palsy with absent adduction, synergistic depression of globe and widening of palpebral fissure on attempted adduction and synergistic elevation and adduction on mouth opening and sideways thrusting of jaw. The case illustrates trigemino-oculomotor synkinesis associated with congenital third nerve palsy. The possible mechanism of miswiring involving the medial longitudinal fasciculus and trigeminal nuclei is discussed. At least some cases of congenital third cranial nerve palsy may fall in the realm of congenital cranial dysinnervation disorders (CCDDs) sharing a much wider spectrum of presentation.

Comparison of Transcorneal and Pars Plana Routes in Pediatric Cataract Surgery in Infants Using a 25-Gauge Vitrectomy System.

PURPOSE: To demonstrate and compare the performance of the 25-gauge transconjunctival sutureless vitrectomy system via anterior (transcorneal) and posterior (pars plana) routes in congenital cataracts in infants. METHODS: In this prospective interventional study, 12 pediatric patients younger than 1 year with bilateral congenital cataract were included to undergo cataract surgery with posterior vitreorhexis and limited anterior vitrectomy using a 25-gauge vitrectomy system. One eye of each patient was operated on by the anterior (transcorneal) route and the other by the posterior (pars plana) route. All eyes were left aphakic. Intraoperative and postoperative (12 months after surgery) results were compared between the two routes, including visual axis opacification and astigmatism. All eyes were rehabilitated with contact lenses or spectacles. RESULTS: The 25-gauge vitrectomy system allowed excellent intraoperative control in both groups. Postoperatively, there was minimal conjunctival congestion, corneal edema, and inflammatory reaction. No intra-operative or postoperative complications were noted in any eye. All eyes had a clear visual axis 12 months after surgery. Mean spherical equivalent was 15.50 ± 2.28 diopters (D) and mean astigmatism was 0.25 ± 0.45 D in the transcorneal group, whereas in the pars plana group it was 15.46 ± 2.45 D and 0.16 ± 0.39 D, respectively, at 12 months, the difference being statistically insignificant (P > .05). CONCLUSIONS: The 25-gauge vitrectomy system allows sutureless surgery with excellent intraoperative control and minimal postoperative inflammation and astigmatism with clear visual axis by both the transcorneal and pars plana routes.