Screening for obstructive sleep apnea amongst patients with retinal vein occlusion.

OBJECTIVE: To evaluate the prevalence and varying severity of obstructive sleep apnea (OSA) amongst those newly diagnosed with retinal vein occlusion (RVO), and screen patients with the use of 2 in-office-administered questionnaires validated against polysomnography. DESIGN: Prospective cross-sectional study. PARTICIPANTS: Consecutive adult patients (≥18 years of age) with a new diagnosis of RVO confirmed with intravenous fluorescein angiography were enrolled. METHODS: The study was conducted at a tertiary academic centre between March 22, 2017, and April 7, 2018. Patients completed the Berlin and STOP-BANG questionnaires screening for OSA at presentation. Diagnostic test properties of the 2 questionnaires compared with polysomnography at a certified sleep laboratory centre as the gold standard for detection of OSA were calculated. RESULTS: A total of 27 patients (37% females) with a mean (standard deviation) age of 69.6 (11.5) years completed the study. The diagnosis of OSA based on polysomnography was made in 96% (41% severe OSA) of patients with RVO. The Berlin questionnaire had a sensitivity of 43% (confidence interval [CI]: 22%-66%) and specificity of 67% (CI: 22%-96%). The STOP-BANG questionnaire had a sensitivity of 86% (CI: 64%-97%) and specificity of 50% (CI: 12%-88%). CONCLUSIONS: Given the high prevalence of severe OSA amongst those with a new diagnosis of RVO, all patients should be strongly considered for polysomnography. The use of in-office questionnaires may aid in triaging urgency of referrals.

Toronto tele-retinal screening program for detection of diabetic retinopathy and macular edema.

BACKGROUND: There are currently low rates of screening for diabetic retinopathy (DR) and sight-threatening diabetic macular edema (DME) in Ontario. OBJECTIVE: To present results of the Toronto Tele-Retinal screening program for patients with diabetes mellitus and to evaluate thebenefit of optical coherence tomography (OCT) in combination with monoscopic colour fundus photographs for detection of DME. METHODS: All electronic medical records for adults with type I and II diabetes mellitus screened through the Toronto Tele-Retinal screening program between September 2013 to August 2017 across 7 sc~reening sites in urban and rural settings were reviewed. Monoscopic colour fundus photographs were graded for presence or absence of DR and DME alone and in combination with OCT scans. RESULTS: A total of 775 patient screens, consisting of 566 first-time screens and 209 re-screens were completed over the 48-month study period. Approximately 37% of all patients with a mean disease duration of 7years had never had an eye examination. Across the sample, 27% of patients had DR, with majority graded to have mild DR, whereas DME was detected in 5% of patients in at least 1 eye. Of all DME detected in the Toronto Tele-Retinal screening program, 38% required the use of adjunct OCT. Other pathologies, including age-related macular degeneration (19%) and glaucomatous or optic nerve findings (8%), were also identified. CONCLUSION: Tele-retinal screening programs may circumvent low rates of DR screening for patients with diabetes mellitus and increase the rate of detection of DME with monoscopic colour fundus photographs and adjunct OCT.

Prevention of posterior capsule opacification by an intracapsular open capsule device.

PURPOSE: To investigate the ability of an open capsule device to prevent posterior capsule opacification. METHODS: A total of 40 eyes of 20 New Zealand white rabbits were randomly divided into six similar groups of 6 to 7 eyes each. After crystalline lens evacuation, one control group (group A) was implanted with a hydrophilic acrylic intraocular lens and no device, and another control group (group B) was implanted with a hydrophobic acrylic intraocular lens and no device. The study groups were implanted with a hydrophilic acrylic intraocular lens and a hydrophilic acrylic device (group C), a hydrophobic acrylic intraocular lens and a hydrophilic acrylic device (group D), a hydrophilic acrylic intraocular lens and a hydrophobic acrylic device (group E), and a hydrophobic acrylic intraocular lens and a hydrophobic acrylic device (group F). The rabbits were monitored for the ensuing 6 weeks and then killed. The enucleated eyes were evaluated using the Miyake-Apple view, Matlab software analysis, and histology. RESULTS: The posterior capsule opacification score was significantly reduced in the eyes that were implanted with the tested device compared with the control eyes (clinical evaluation: 69% reduction, P = 0.001; the Miyake-Apple view analysis: 77% reduction, P = 0.000; histology: 75% reduction, P = 0.000). Soemmering's ring area was significantly reduced in the eyes implanted with the tested device compared with the control eyes (Matlab analysis: 80% reduction, P = 0.000). CONCLUSIONS: The tested devices were effective in reducing posterior capsule opacification and Soemmering's ring formation.