Improving Compliance to Follow-Up Care After Primary Emergency Department Ophthalmic Consultation.

PURPOSE: To identify factors that affect the likelihood of follow-up after emergency department (ED) visit for ophthalmic complaints and to evaluate a protocol to improve compliance. DESIGN: Prospective interventional study with historical controls. METHODS: This study was conducted at Jamaica Hospital Medical Center in Jamaica, New York. The study population included 962 patients who presented to the ED and who required ophthalmology consultation. Participants in the control group were given only verbal follow-up instructions. Participants in the intervention group were given verbal instructions, written instructions, telephone calls, and, if not responding to calls, a mailed letter. The primary outcome was the overall follow-up rate. Secondary outcomes were follow-up rate by demographic subgroup. RESULTS: Patients in the intervention group were significantly more likely to follow up (68.8% vs 42.9%, P < .001). Nearly all subgroups exhibited significantly improved follow-up with the intervention, with the exception of patients 18 to 29 years of age, patients with diagnosis severity class III, patients with no insurance, patients with hospital financial aid, patients paying with workers' compensation, and patients with an unknown employment status. CONCLUSIONS: Before the intervention, most patients receiving ophthalmology consultation in the ED did not return for follow-up care. These patients tended to be young, unemployed, uninsured or use hospital financial aid, were in the control group, had good visual acuity, reported no change in vision, and had a condition that was not vision-threatening. Follow-up rates were improved in nearly all subgroups by providing written instructions, telephone calls, and mailed letters. Such instructions should be considered in similar populations.

Deep anterior lamellar keratoplasty for acanthamoeba keratitis complicating the use of Boston scleral lens.

BACKGROUND: This is the first reported case of Acanthamoeba keratitis (AK) in a Boston scleral lens user. Consequently, the risk factors and treatment for AK need to be addressed in this unique case. METHODS: We conducted a retrospective case study of a 45-year-old man using Boston scleral lens diagnosed with AK. Risk factors for infection and management of the condition were assessed. RESULTS: This 45-year old Boston scleral lens user's risk factors for developing AK included dry eye syndrome, autologous serum tear use, potential tap water exposure, and long-term systemic corticosteroid use. His infection was refractory to medical management and required deep anterior lamellar keratoplasty for curative treatment. CONCLUSION: Ophthalmologists should have a higher level of suspicion for AK in all scleral lens users and consider the use of deep anterior lamellar keratoplasty for refractory cases.

Small human islets comprised of more ß-cells with higher insulin content than large islets.

For the past 30 years, data have suggested that unique islet populations exist, based on morphology and glucose sensitivity. Yet little has been done to determine the mechanism of these functional differences. The purpose of this study was to determine whether human islets were comprised functionally unique populations, and to elucidate a possible mechanism. Islets or pancreatic sections from 29 human donors were analyzed. Islets were isolated and measured for insulin secretion, cell composition and organization, insulin and glucagon granule density and insulin content. Insulin secretion was significantly greater in small compared with large islets. In sectioned human pancreata, ß-cells comprised a higher proportion of the total endocrine cells in small islets (63%) than large islets (39%). A higher percentage of ß-cells in small islets contacted blood vessels (44%) compared with large islets (31%). Total insulin content of isolated human islets was significantly greater in the small (1323 ± 512 µIU/IE) compared with large islets (126 ± 48 µIU/IE). There was less immunostaining for insulin in the large islets from human pancreatic sections, especially in the core of the islet, compared with small islets. The results suggest that differences in insulin secretion between large and small islets may be due to a higher percentage of ß-cells in small islets with more ß-cells in contact with blood vessels and a higher concentration of insulin/ß-cell in small islets.