Dry eye in the upper blepharoplasty patient: a study comparing orbicularis-sparing versus orbicularis-excising techniques.

PURPOSE: To compare subjective and objective dry eye syndrome (DES) metrics preoperatively and postoperatively in patients undergoing bilateral upper eyelid blepharoplasty (ULB) using orbicularis-sparing versus orbicularis-excising techniques. METHODS: A double-blind, randomized clinical trial was conducted on patients without prior DES or other severe conditions who presented to our institution between 2017 and 2019 for routine functional ULB. Patients were randomized into two treatment arms: bilateral ULB using the orbicularis-sparing technique or bilateral ULB using the orbicularis-excising technique. One subjective and seven objective DES assessments were performed on all patients preoperatively and 1 month and 1 year after surgery. RESULTS: A total of 63 patients were recruited for the study. Standard Patient Evaluation of Eye Dryness (SPEED) scores decreased in both treatment groups at 1 month and 1 year postoperatively. This change did not significantly vary based on surgical technique. Objective DES assessments were not significantly changed at both postoperative time points for either group. There was a correlation between the severity of preoperative DES symptoms and the subjective improvement of DES symptoms postoperatively in both groups. CONCLUSIONS: ULB with an orbicularis-sparing or orbicularis-excising technique does not worsen subjective or objective DES metrics and so, surgeons may confidently use either surgical technique. These findings may impact postoperative expectations for surgeons and patients alike.

Comparing the Diagnostic Utility of Conventional Direct Ophthalmoscopy with Smartphone Ophthalmoscopy among Medical Students.

Purpose To compare the diagnostic ability of medical students using smartphone ophthalmoscopy (SO) with conventional direct ophthalmoscopy (DO). Methods Twenty-eight first- and second-year medical students were trained to use the SO and DO. They also attended educational seminars regarding optic nerve and retinal pathology and were given hands-on practice with each ophthalmoscopy method. Students were randomized 2:1 into one of the groups (DO or SO). Students then examined six patients and recorded their findings, ease of use, and confidence level on a questionnaire. Two attending ophthalmologists, masked to the randomization, graded the student questionnaires. A priori power calculation determined the sample size. The primary outcome measure was the percentage of correct diagnoses the students made. Two-sample t -test, Wilcoxon's rank-sum test, and Fisher's exact test were used to compare the outcomes. Results Students using the SO outperformed students using DO in terms of mean percent correct (% correct) diagnosis (smartphone: 42% vs. direct: 23%; p -value = 0.0057), mean % correct photo match (smartphone: mean = 60% vs. direct: 32%; p -value = 0.0052), and mean % correct nerve/retinal descriptors (smartphone: 72% vs. direct: 59%; p -value = 0.0048). There was not a significant difference in terms of perceived ease of use (smartphone: mean = 3.3 vs. direct: mean = 2.6; p -value = 0.0945), or subjective confidence (smartphone: mean = 2.6 vs. direct: mean = 2.1; p -value = 0.0808) between the two groups. Conclusion SO provides an alternate way for medical students to learn, diagnose, and describe ocular pathology.

Temporal Profile of Retinopathy of Prematurity in Extremely Premature Compared to Premature Infants.

PURPOSE: To compare the time course of retinopathy of prematurity (ROP) in premature (≥ 28 to 34 weeks' gestational age) and extremely premature (< 28 weeks' gestational age) infants. METHODS: This study was a retrospective single-center chart review that included 582 eyes (122 premature, 464 extremely premature) of 299 infants (65 premature, 234 extremely premature) diagnosed as having ROP who were born between January 1, 2010, and December 31, 2015. Data collected were analyzed with shared frailty models, chi-square, and Fisher's exact tests. RESULTS: Extremely premature infants were diagnosed as having ROP earlier than premature infants at 33.6 weeks (95% CI [confidence interval]: 33.4 to 33.9) versus 36.0 weeks (95% CI: 34.7 to 36.4, P < .0001). The time from diagnosis to spontaneous regression was more than 4 weeks longer for extremely premature infants than premature infants with stage 1 ROP (82.0 vs 50.0 days, P < .0001), and more than 6 weeks longer for extremely premature infants than premature infants with stage 2 ROP (99 vs 55 days, P < .0001). Extremely premature infants had more bilateral ROP (96.6% vs 87.1%, P < .01) and were three times more likely to require treatment than premature infants (29.7% vs 9.9%, P < .0001). On average, infants who required treatment weighed 137 grams less at birth (P < .0001) and gained 37.7 grams less per week than infants who underwent spontaneous regression (P < .0001). CONCLUSIONS: Extremely premature infants developed ROP earlier, had more bilateral ROP, took longer to achieve spontaneous regression, and required treatment more often than premature infants. Infants who required treatment had a lower birth weight and rate of weight gain than infants who underwent spontaneous regression. [J Pediatr Ophthalmol Strabismus. 2019;56(2):116-123.].