ABSTRACT
PURPOSE: To evaluate the incidence of severe ocular injury requiring emergent ophthalmic evaluation in visually asymptomatic patients presenting with orbital fractures. METHODS: We performed a retrospective chart review of all adult and pediatric orbital fractures between 2012-2022 at a level 1 trauma center. Ocular injuries were categorized into severe, moderate, and mild. We evaluated symptoms, mechanism of injury, visual acuity (VA), and severity of injuries using the Cochran-Armitage and linear-by-linear tests. RESULTS: Of the 2495 cases, 1534 had ophthalmology evaluation. The mean ± standard deviation age was 40.4 ± 20.4 years. Most patients were male (73.1%) and Caucasian (75.9%). The mean time to evaluation was 0.6 ± 2.5 days. 486 (31.7%) were visually symptomatic, 760 (49.5%) were asymptomatic, and 288 (18.8%) were unknown. Of the symptomatic, 135 (27.8%) had severe injuries, 108 (22.2%) had moderate injuries, 216 (44.4%) had mild injuries, and 27 (5.6%) had no injuries. Of the asymptomatic, 67 (8.8%) had severe injuries, 183 (24.1%) had moderate injuries, 468 (61.6%) had mild injuries, and 42 (5.5%) had no injuries. Symptoms correlated with injury severity (p-value <.001). The most common mechanism of injury were falls (24.0%), assaults (22.2%), and motor vehicle accidents (14.8%). CONCLUSIONS: Visually asymptomatic orbital fractures were less likely to have severe ocular injuries; however, many patients were unable to express symptoms. Emergent ophthalmology evaluation should be considered in all patients presenting with orbital fractures, especially patients with visual symptoms or are unable to report symptoms.
Subject(s)
Eye Injuries , Orbital Fractures , Humans , Adult , Male , Child , Young Adult , Middle Aged , Female , Orbital Fractures/epidemiology , Orbital Fractures/complications , Incidence , Retrospective Studies , Eye Injuries/epidemiology , Eye Injuries/etiology , Visual AcuityABSTRACT
This clinical case report describes a single case of a progressively enlarging anterior chamber cyst arising in a patient with prior cataract surgery. We detail findings of a large implantation cyst within the anterior chamber, confirmed on ultrasound biomicroscopy. The patient was successfully treated with needle aspiration and injection of 5-fluorouracil without recurrence at 5 months. Anterior chamber cysts are a rare side effect of cataract surgery caused by intrusion of epithelial cells during surgery. Patients may present with a progressively enlarging mass requiring surgical intervention. Aspiration and injection of a cytodestructive chemical agent is one conservative approach in the management of an implantation cyst, with our patient exhibiting favorable visual outcomes.
ABSTRACT
The Navajo Nation is the largest Native American reservation by area and citizenship. The study sought to provide the first large-scale examination of ocular pathology within this population. A retrospective review of all Navajo patients seen at Moran Eye Center Navajo Nation Outreach Clinics from 2013 to 2021 for demographics, visual acuity, refractive, and eye pressure data was undergone. Further variables included comorbidity and eye diagnoses among patients at these clinics. Results: First-time patient visits totaled 2251 from 2013 to 2021. The median age was 53 (range, 18 to 92), and clinics had a predominance of female patients (1387:864). Among patients presenting without glasses, 20.67% (198/958), 9.71% (93/958), and 3.13% (30/958) had mild visual impairment (VI), moderate to severe VI, and blindness, respectively. Cataracts were the most common cause of blindness in these patients (40%, 12/30) and the need for glasses was the second most common cause (33%, 10/30). From 2016 to 2021, 17.71% (48/271) of diabetic patients were diagnosed with diabetic retinopathy (DR). Within the subset of Navajo patients that presented without any correction, 73% of bilateral blindness was preventable via glasses prescription or cataract surgery. This study comments on questions of equitable care for Navajo patients.
ABSTRACT
BACKGROUND: To compare screening referral recommendations made by remotely located ophthalmic technicians with those of an ophthalmologist examining digital photos obtained by a portable ophthalmic camera system powered by an iOS handheld mobile device (iPod Touch). METHODS: Dilated screening eye exams were performed by ophthalmic technicians in four remote districts of Nepal. Anterior and posterior segment photographs captured with a Paxos Scope ophthalmic camera system attached to an iPod Touch 6th generation device were uploaded to a secure cloud database for review by an ophthalmologist in Kathmandu. The ophthalmic technicians' referral decisions based on slit-lamp exam were compared to the ophthalmologist's recommendation based on the transmitted images. RESULTS: Using the transmitted images, the ophthalmologist recommended referral for an additional 20% of the 346 total subjects screened who would not have been referred by the ophthalmic technician. Of those subjects, 34% were referred to the retina clinic. Conversely, among the 101 patients referred by the technician, the ophthalmologist concurred with the appropriateness of referral in more than 97% of cases but thought eight (2.8%) of those patients had variants of normal eye pathology. CONCLUSION: An ophthalmologist who reviewed data and photos gathered with the mobile device teleophthalmology system identified a significant number of patients whose need for referral was not identified by the screening technician. Posterior segment pathology was most frequently found by the remote reader and not by the technician performing dilated slit lamp examinations. These results are promising for further clinical implementation of handheld mobile devices as tools for teleophthalmic screening in resource-limited settings.
ABSTRACT
Glaucoma is a chronic eye disease affecting millions of people worldwide; it is frequently treated with daily eyedrop medications when patients are asymptomatic. Patient education is an essential feature for adherence to treatments. Developing useful patient education interventions is predicated on understanding what glaucoma patients know about their disease and identifying gaps in their knowledge. Thirteen studies that have measured and described glaucoma patient knowledge using questionnaires were identified from the literature, including cross-sectional studies of disease knowledge and studies evaluating the efficacy of an educational intervention, both randomized controlled and observational. All studies found significant knowledge gaps in glaucoma patients. Both the controlled studies and the observational studies supported the efficacy of various educational interventions for improving glaucoma knowledge.
Subject(s)
Glaucoma , Health Knowledge, Attitudes, Practice , Medication Adherence , Cross-Sectional Studies , Glaucoma/drug therapy , Glaucoma/etiology , Humans , Medication Adherence/psychology , Medication Adherence/statistics & numerical data , Patient Education as Topic/methods , Patient Preference , Quality of LifeABSTRACT
SUMMARY: To develop metrics to identify knowledge deficits and barriers to learning in glaucoma patients, this study seeks to validate a glaucoma knowledge assessment to use in the evaluation of knowledge in glaucoma patients. PURPOSE: Glaucoma treatment adherence appears to improve when patients demonstrate a greater knowledge of the disease and its treatment. This study seeks to validate a glaucoma knowledge assessment in a glaucoma patient population to assist in patient educational assessments and interventions. PATIENTS AND METHODS: The National Eye Health Education Program's (NEHEP) glaucoma knowledge assessment has previously been suggested as a useful measure to assess glaucoma patient's knowledge. This questionnaire was administered in glaucoma patients along with a more comprehensive 49-question examination. Demographic data and health literacy were assessed. Statistical analyses were performed to assess the validity of the assessments. RESULTS: A total of 12 glaucoma patients completed the knowledge assessments. The mean ± standard deviation age of the patients was 69±14 years, and the duration of glaucoma was 14±13 years. The participants' mean score on the NEHEP assessment was 7.3±0.8 (of 10, 73% correct) vs 29.3±7.3 (of 49, 60% correct) on the comprehensive assessment. The value of coefficient α was 0.592 for NEHEP and 0.872 for the cumulative assessment. The P-value (proportion of examinees answering correctly) ranged from 0 to 1 for individual questions. Item point-biserial correlation values for each question ranged from -0.402 to 0.813. DISCUSSION: The NEHEP quiz may be a good starting point for the development of a reliable knowledge assessment tool to measure and monitor glaucoma knowledge, due to its concise nature and reasonable level of difficulty. This study suggests that questions included in the currently available questionnaires vary widely in difficulty and ability to differentiate knowledge level, which may ultimately compromise reliability and utility of existing examinations. Further examination of individual questions and teaching points included in the current assessments may help to construct increasingly reliable and useful knowledge assessments in the future.
ABSTRACT
La vía más adecuada para la resección del cáncer de esófago es un tema controvertido. El objetivo de este trabajo es comparar los resultados de la vía transhiatal (TH) y transtorácica (TT) en la cirugía del cáncer de esófago
Subject(s)
Humans , Male , Adult , Comparative Study , Esophageal Neoplasms/surgery , General Surgery/methods , Specialties, Surgical/methods , Esophagoscopy , Intraoperative Period , Postoperative PeriodABSTRACT
La vía más adecuada para la resección del cáncer de esófago es un tema controvertido. El objetivo de este trabajo es comparar los resultados de la vía transhiatal (TH) y transtorácica (TT) en la cirugía del cáncer de esófago
Subject(s)
Humans , Male , Adult , General Surgery/methods , Esophagoscopy , Specialties, Surgical/methods , Esophageal Neoplasms/surgery , Intraoperative Period , Postoperative PeriodABSTRACT
La pancreatitis aguda grave origina frecuentemente colecciones pancreáticas y peripancreáticas, el tratamiento de elección del seudoquiste de páncreas es aún un tema controversial. El objetivo de este trabajo es analizar una serie consecutiva de casos y su tratamiento
Subject(s)
Humans , Male , Adult , Female , Pancreatitis , Pancreatitis, Acute Necrotizing , Pancreatic Pseudocyst/surgery , General SurgeryABSTRACT
La pancreatitis aguda grave origina frecuentemente colecciones pancreáticas y peripancreáticas, el tratamiento de elección del seudoquiste de páncreas es aún un tema controversial. El objetivo de este trabajo es analizar una serie consecutiva de casos y su tratamiento
