Repeatability, reproducibility, agreement, and safety of Tono-Pen tip cover for intraocular measurement using latex and polyethylene wrap.

PURPOSE: To evaluate repeatability, reproducibility, and agreement of intraocular pressure measurement with Tono-Pen using Ocufilm and polyethylene wrap tip cover in human eyes. METHODS: This is a cross-sectional, experimental study. A gas-sterilized, polyethylene wrap was used as an alternative for Tono-Pen tip cover. For the right eye, 4 measurements using polyethylene wrap tip cover were done by two examiners (A and B) in random order to assess intra-observer repeatability and inter-observer reproducibility. For the left eye, 4 measurements were done by examiner A using both polyethylene wrap tip cover and Ocufilm in random order to assess intra-observer repeatability and agreement. Bland-Altman plot and intraclass correlation coefficient (ICC) were used in all analyses. Cost minimization analysis was evaluated. RESULTS: For examiner A, the repeatability of polyethylene wrap tip cover was -0.34, 95% limits of agreement (LOA) were -3.04 to 2.36, and ICC was 0.93 in the right eyes. As for the left eyes, the repeatability of polyethylene wrap tip cover was -0.33, 95% LOA were -3.01 to 2.36, and ICC was 0.93. For examiner B, the repeatability of polyethylene wrap tip cover was -0.02, 95% LOA were -2.88 to 2.83, and ICC was 0.92. The inter-observer reproducibility of polyethylene wrap tip cover was 0.36, 95% LOA were -3.34 to 4.07, and ICC was 0.90. The repeatability of Ocufilm was -0.42, 95% LOA were -2.75 to 1.91, and ICC was 0.95. The agreement of polyethylene wrap tip cover and Ocufilm was -0.71, 95% LOA were -5.18 to 3.76, and ICC was 0.83. There were no allergic reactions or serious complications. From the cost minimization analysis, the local cost for polyethylene tip cover was approximately 8 times lower compared to Ocufilm. CONCLUSIONS: Tono-pen with Ocufilm and polyethylene wrap tip cover were used to measure the intraocular pressure. The polyethylene wrap tip cover demonstrated acceptable repeatability, reproducibility, and agreement with Ocufilm in normotensive eyes, and had a good safety profile.

Diagnostic accuracy of a digital fundus photographic system for detection of retinopathy of prematurity requiring treatment (ROP-RT).

OBJECTIVES: To evaluate the diagnostic accuracy of a digital fundus photographic system that consists of taking fundus photographs by a trained technician using a RetCam® shuttle and interpreting fundus images by an expert to detect Retinotapthy of Prematurity requiring treatment (ROP-RT) which defined as type I ROP according to the Early Treatment for ROP study (ETROP). MATERIALS AND METHODS: One hundred infants were examined by (1) an expert ophthalmologist experienced in ROP care using indirect ophthalmoscopy; (2) digital wide-field imaging by a trained technician using a RetCam® shuttle and images were sent remotely for interpretation by two ophthalmologists experienced in ROP care (Reader A, and Reader B); and (3) local ophthalmologists using indirect ophthalmoscopy. The diagnostic acurracy consisting of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were calculated. Agreement between all examiners and readers were evaluated. RESULTS: A total of 100 infants (mean gestational age 31.1 weeks, mean birth weight 1,511.1 grams) participated in the study. Nine infants were classified as ROP-RT. Reader A and B had very good agreement in detection of ROP- RT (Kappa 1.00, 95% CI 1.00, 1.00). For reader A, diagnostic performance parameters (95% confidence intervals) for detecting ROP-RT were; sensitivity 100.0% (66.4, 100.0), specificity 97.8% (92.1, 99.7), PPV 81.8% (48.2, 97.7), NPV 100.0% (95.8, 100.0), LR+ 44.5 (11.3, 175.2), and LR- 0.1 (0.0, 0.8). For reader B these were; sensitivity 100.0% (66.4, 100.0), specificity 95.6% (89.0, 98.8), PPV 69.2% (38.6, 90.9), NPV 100.0% (95.8, 100.0), LR+ 22.5 (8.6, 58.6), LR- 0.1 (0.0, 0.8). No adverse events were reported. CONCLUSIONS: Diagnosis of ROP-RT from RetCam® images taken by trained technicians and evaluated remotely by an expert ophthalmologist had good diagnostic accuracy for screening purposes.

Ocular involvement in melioidosis: a 23-year retrospective review.

BACKGROUND: Ocular involvement in melioidosis is rare and has devastating outcomes. Although there have been few reports on the condition, Khon Kaen, a city in northeast Thailand, has been called the "capital of melioidosis" due to the high prevalence of the condition in the region. We retrospectively reviewed all admitted cases of melioidosis with ocular involvement from the two largest hospitals in Khon Kaen. We reviewed cases from Srinagarind Hospital (a university hospital) of patients admitted between 1993 and 2016 and from Khon Kaen Hospital (a provincial hospital) of patients who presented from 2012 to 2016. RESULTS: We identified 16 cases of ocular involvement. Eight of these cases were proven from positive culture, and the remaining eight were implied from high melioidosis titer. The prevalence was estimated as being from 0.49 to 1.02%. Most patients had underlying diseases (14, 88%), of which diabetes mellitus was the most prevalent (12, 75%). Nine cases (56%) were part of disseminated septicemia. Patients suffered from blindness in 11 (73%) of the 15 cases in which visual acuity was recorded. Orbital cellulitis was the most common manifestation (7, 44%) followed by endophthalmitis (4, 25%). Interestingly, all patients with necrotizing fasciitis (100%) developed septic shock as a consequence. In most of the cases, patients underwent surgery (13, 81%) including incision and drainage, debridement, and pars plana vitrectomy. Despite appropriate management, the visual outcomes were disappointing (9, 64%). CONCLUSION: To summarize, ocular melioidosis is a highly destructive disease. Early detection and prompt surgical management may reduce morbidity and mortality from septic shock.

Prevalence of Visual Impairment among 4- to 6-years-old Children in Khon Kaen City Municipality, Thailand.

Objective: To evaluate the prevalence of visual impairment of children aged four to six years in Khon Kaen City Municipality, Thailand. Material and Method: The visual acuity test was performed on 1,286 children in kindergarten schools located in Khon Kaen Municipality. The first test of visual acuity was done by trained teachers and the second test by the pediatric ophthalmologist. The prevalence of visual impairment of both tests was recorded including sensitivity, specificity, likelihood ratio, and predictive value of the test by teachers. The causes of visual impairment were also recorded. Results: There were 39 children with visual impairment from the test by the teacher and 12 children from the test by the ophthalmologist. Myopia is the single cause of visual impairment. Mean spherical equivalence is 1.375 diopters (SD = 0.53). Median spherical equivalence is 1.375 diopters (minimum = 0.5, maximum =4). The detection of visual impairment by trained teachers had a sensitivity of 1.00 (95% CI 0.76-1.00), specificity of 0.98 (95% CI 0.97-0.99), likelihood ratio for a positive test 44.58 (95% CI 30.32-65.54), likelihood ratio for a negative test 0.04 (95% CI 0.003-0.60), positive predictive value of 0.31 (95% CI 0.19-0.47), and negative predictive value of 1.00 (95% CI 0.99-1.00). Conclusion: The prevalence of visual impairment among children aged four to six year old is 0.9%. Trained teachers can be examiners for screening purpose.

Comparisons of Amplitude Reduction of Pattern Visual Evoked Potential (VEP) and Flash VEP between Using Srinagarind Eye Patch and Commercial Eye Patch in Normal Subjects.

OBJECTIVE: To compare the difference of amplitude reduction of pattern VEP and flash VEP between occluding eye with Srinagarind eye patches and commercial eye patches in normal subjects. MATERIAL AND METHOD: Fifteen subjects (7 males and 8 females) who had normal eye examinations were enrolled. Amplitude of pattern VEP was recorded for each individual subject as baseline data. Right eyes were occluded with Srinagarind eye patches and fellow eyes with commercial eye patches (3M) and then the VEP were retested (pattern and flash VEP). The reduction of amplitude in pattern and flash VEP was recorded. RESULTS: The commercial eye patch significantly reduced the amplitude of retinal stimulation by pattern reversal stimuli on pattern VEP better than the Srinagarind eye patch 1.68 µV (95% CI 0.48-2.87). The commercial eye patch group had amplitude of retinal stimulation by light stimulation on flash VEP greater than the Srinagarind eye patch 3.92 µV (95% CI -9.25-1.41), but not statistically significant. There was also no report of any serious side effects in either group. CONCLUSION: This is the first study aiming to demonstrate the ability of the Srinagarind eye patch to reduce the retinal stimulation compared with the commercial eye patch by using the VEP test. Further study is needed to test the effectiveness of the Srinagarind eye patch.

Health related quality of life instruments for glaucoma: a comprehensive review.

Health related quality of life (HRQOL) outcome is becoming important and of interest for clinicians and patients alike. HRQOL can be affected immediately after the initial diagnosis of the disease through anxiety of blindness. Further impairment in various aspects of HRQOL is expected over time as the disease progresses, reducing daily activities. Without a gold standard for HRQOL construct in this population, a number of instruments have become available with different characteristics and foci. This article reviews published HRQOL instruments and their psychometric properties in glaucoma patients. Of the 10 instruments reviewed, 2 were generic, 4 were vision-specific and 4 were glaucoma-specific instruments. Overall, vision- and glaucoma-specific instruments appear to be more sensitive than generic instruments in detecting potential changes of HRQOL in the patients. The shortcoming of existing instruments, however, arises from being predominantly focused on physical functions while omitting other aspects relevant to patients HRQOL such as psychological and social well-being. In addition, many vision-specific instruments have inadequate coverage of important issues, such as peripheral and color vision, which are affected by glaucoma disease. Validation of the instruments using various magnitudes of visual field is warranted and further investigation of their responsiveness is required for them to be more useful for outcome evaluation in the clinical setting. Refinement of an instrument to enhance the incorporation of HRQOL in routine management of patients with glaucoma is briefly described.