Validity and reliability of the Thai version of the ASCRS SPEED II preoperative OSD questionnaire in Thai cataract surgery candidates.

OBJECTIVES: To develop a Thai version of the American Society of Cataract and Refractive Surgery (ASCRS)-modified Standard Patient Evaluation of Eye Dryness (SPEED) II© preoperative ocular surface disease (OSD) questionnaire (ASCRS SPEED II-Thai) and evaluate its validity and reliability in Thai cataract surgery candidates. METHODS: The original English version of the questionnaire was translated and adapted cross-culturally to Thai language. The ASCRS SPEED II-Thai was evaluated for content validity, internal consistency, and test-retest reliability. Five experts in the ocular surface field critically reviewed the ASCRS SPEED II-Thai to measure the content validity indexes (CVI). A total of 105 cataract surgery candidates were recruited from an ophthalmology clinic to complete the questionnaire. Cronbach's alpha and intraclass correlation coefficient (ICC) were calculated to assess internal consistency and test-retest reliability, respectively. RESULTS: During the translation and cross-cultural adaptation processes, only two minor modifications were made to the original version for clarification without changing their meaning. All items in the ASCRS SPEED II-Thai had an item-level CVI of 1.00, representing complete agreement among content experts. The scale-level CVI was 1.00, indicating excellent content validity of the questionnaire. The participants found no difficulty in understanding each question in the pilot test. Cronbach's alpha for the ASCRS SPEED II-Thai was 0.82, indicating good internal consistency. The test-retest reliability was good to excellent, with ICC values ranging from 0.83 to 1.00 (P < 0.001). CONCLUSIONS: The ASCRS SPEED II-Thai is a valid clinical tool with adequate reliability for preoperative OSD screening among Thai cataract surgery candidates.

Compliance with Lid Hygiene in Patients with Meibomian Gland Dysfunction.

Purpose: To evaluate the level and predictor of compliance with lid hygiene of the patients with meibomian gland dysfunction (MGD) by a specially designed and validated questionnaire. Patients and Methods: A cross-sectional, descriptive study was conducted among patients with symptomatic meibomian gland dysfunction visiting at Ramathibodi Hospital from April 2019 to December 2020. Dry eye symptom, fluorescein tear breakup time (TBUT), ocular surface staining, lid morphology, meibum quality, and meibum expressibility were evaluated. All patients were instructed to perform lid hygiene two times daily. Eight weeks after receiving the instruction, the patients were asked to complete a newly developed seven-item questionnaire to assess compliance. The associated factors limiting treatment adherence were evaluated. Proper statistical analyses were used to determine the relationships between compliance and non-compliance and a group of relevant baseline variables. P < 0.05 was considered to be statistically significant. Results: A total of 77 patients were recruited into the study. Sixty-three patients (81.8%) were female. The mean age was 66.71 ± 8.17 years old (42-87 years). Good compliance with lid hygiene was reported by 42 patients (54.6%). Patient demographic factors or the number of concurrent systemic or ophthalmic drugs were not significantly different between the compliance and non-compliance groups. Some clinical signs, including the higher scores of meibomian gland expressibility and moderate to severe ocular surface staining, were significantly positively associated with lid hygiene compliance (χ 2 = 10.13, P = 0.001 and χ 2 = 10.48, P = 0.001, respectively). A lack of time was the most notable reason for non-compliance. Conclusion: Approximately half of the patients with symptomatic MGD had good compliance with lid hygiene by the specific questionnaire. Appropriate patient education and optimization methods of lid hygiene may promote patient compliance.

CYTOMEGALOVIRUS RETINITIS SCREENING USING MACHINE LEARNING TECHNOLOGY.

PROPOSE: A screening protocol for cytomegalovirus retinitis (CMVR) by fundus photography was generated, and the diagnostic accuracy of machine learning technology for CMVR screening in HIV patients was investigated. METHODS: One hundred sixty-five eyes of 90 HIV-positive patients were enrolled and evaluated for CMVR with binocular indirect ophthalmoscopy. Then, a single central field of the fundus image was recorded from each eye. All images were then interpreted by both machine learning models, generated by using the Keras application, and by a third-year ophthalmology resident. Diagnostic performance of CMVR screening using a machine learning model and the third-year ophthalmology resident were analyzed and compared. RESULTS: Machine learning model, Keras application (VGG16), provided 68.8% (95% confidence interval [CI] = 50%-83.9%) sensitivity and 100% (95% CI = 97.2%-100%) specificity. The program provided accuracy of 93.94%. However, the sensitivity and specificity for the third-year ophthalmology grading were 67.7% (95% CI = 48.6%-83.3%) and 98.4% (95% CI = 94.5%-99.8%). The accuracy for CMVR classification was 89.70%. When considering for sight-threatening retinitis in Zone 1 and excluded Zones 2 and 3, the machine learning model provided high sensitivity of 88.2% (95% CI = 63.6%-98.5%) and high specificity of 100% (95% CI = 97.2%-100%). CONCLUSION: This study demonstrated the benefit of the machine learning model VGG16, which provided high sensitivity and specificity for detecting sight-threatening CMVR in HIV-positive patients. This model is a useful tool for ophthalmologists in clinical practice for preventing blindness from CMVR, especially during the Coronavrus Disease 2019 pandemic.

Agreement of implantable collamer lens sizes using parameters from different devices.

Objective: To assess agreement and repeatability of white-to-white (WTW) and anterior chamber depth (ACD), and agreement of implantable collamer lens (ICL) size using these measurements from different devices. Methods and analysis: A retrospective review of 83 eyes with ICL implantation (42 patients) was conducted. The agreement of WTW (measured with WaveLight Topolyzer and Orbscan IIz) and ACD (measured with WaveLight Oculyzer and Orbscan IIz) was analysed. Correlation of ICL sizes and difference of eyes with unacceptable vaults between two data sets (WaveLight platform; Topolyzer and Oculyzer and Orbscan IIz) were assessed. Results: Average WTW measured by Orbscan IIz and Topolyzer demonstrated good agreement (Ρ 0.884) with low systematic bias (-0.03±0.1 mm) and narrow 95% limits of agreement (LoA) of -0.28 to 0.22. Average ACD measured by Orbscan IIz and Oculyzer also showed good agreement (Ρ 0.903) with low systematic bias (-0.04±0.1 mm) and relatively narrow 95% LoA (0.2 to 0.12). ICL size selected according to two data sets showed moderate to strong level of agreement (Kappa=0.81). There was a statistically significant difference (p<0.001) in the proportion of eyes with unacceptable postoperative vaults when using the Wavelight platform data set (five eyes, 6.02%) and the Orbscan IIz data set (12 eyes, 14.46%). Conclusion: Although the agreement of WTW and ACD between devices was good, there was a significant difference in proportion of eyes with unacceptable postoperative vaults when using two data sets. Therefore, Topolyzer and Oculyzer might not be suitable for operating interchangeably with Orbscan IIz for ICL size selection.

Outcomes of Descemet Membrane Endothelial Keratoplasty in Bangkok, Thailand.

PURPOSE: To investigate the medium-term clinical outcomes and risk factors for primary graft failure after Descemet membrane endothelial keratoplasty (DMEK) in Thai patients. PATIENTS AND METHODS: This is a single-center retrospective cohort study. Sixty-two eyes of 62 patients who underwent DMEK at Ramathibodi Hospital, Bangkok, Thailand, with a minimum of 24-month follow-up were recruited. Preoperative donor and recipient characteristics, intraoperative data, and postoperative outcomes including best-corrected visual acuity (BCVA), graft clarity, endothelial cell density (ECD), central corneal thickness (CCT), and complications were evaluated at 1, 3, 6, 12, and 24 months after surgery. RESULTS: The mean age of the patients was 67.2 ± 9.9 years, and 52% were female. The mean follow-up time was 37.5 ± 11.0 months. The most common indications for DMEK were Fuchs' endothelial corneal dystrophy (FECD) (53.2%) and pseudophakic bullous keratopathy (PBK) (17.7%). Nearly half of patients had triple-DMEK. The median preoperative BCVA was 20/400. Postoperative BCVA of ≥ 20/40 was reached in 37.1% and of ≥ 20/20 in 6.5% after 1 month which increased to 54.8% and 17.7% after 3 months; and to 67.7% and 27.4% after 24 months. Endothelial cell loss (ECL) at 3, 6, 12, and 24 months was 30.5%, 33.8%, 44.4%, and 45.9%, respectively. Graft diameter was the single factor, showing a significant relationship with postoperative ECD. Most frequent postoperative complications included graft detachment (22.6%), increased IOP/glaucoma (17.7%), and primary graft failure (16.1%). In univariate analysis, death-to-operation time and the diagnosis of PBK were significantly associated with the occurrence of primary graft failure. CONCLUSION: DMEK is a safe, effective, and feasible treatment for endothelial failure in Asian eyes. Careful case selection, use of relatively fresh donor tissues, and appropriate surgical techniques can prevent primary graft failure and facilitate optimal outcomes following surgery.

Multimodal Imaging Report of Crystalline Keratopathy in Relapsing Polychondritis.

PURPOSE: To describe a case of bilateral multifocal stromal crystalline keratopathy in the setting of relapsing polychondritis (RP). METHODS: Case report. RESULTS: We describe a 31-year-old woman who presented with ocular inflammation, bilateral auricular chondritis, and nasal chondritis, meeting the clinical criteria of RP. We illustrate her auricular cartilaginous abnormalities, saddle nose deformity, scleritis, and discrete mid-stromal opacities in both corneas that extend through the central cornea. Uniquely, her opacities feature a marked crystalline component as demonstrated on photography, anterior segment optical coherence tomography, and confocal microscopy. CONCLUSION: A central keratopathy is not typically reported in patients with RP. In this case report, we describe a unique diffuse bilateral nummular mid-stromal crystalline keratitis that extends into the central cornea and further define it using multimodal imaging.