Assessment of Direct Costs of Admission Due to Presumed Microbial Keratitis in a Tertiary Referral Hospital in Thailand: A 7-Year Retrospective Study.

Objective: To evaluate the direct healthcare cost of admission and examine the effects of cost drivers of treating presumed microbial keratitis (MK) at a tertiary referral hospital. Design: Retrospective study. Methods: A total of 741 patients who presented with MK were included. All information regarding costs was collected, and demographic data were employed for risk factor analysis. Results: The total cost of treating MK over a 7-year period at Rajavithi Hospital was US$14,514,625.04, while the median cost was US$10,840.17 per patient (Q1-3, US$5866.56-24,172.28). The medical professional services were the highest cost category in terms of both total cost of treatment over 7 years and median cost per patient, accounting for US$6,474,718.43 and US$5235.20 (Q1-3, US$2582.79-10,474.24) respectively. In 2020, the total cost of treatment declined, corresponding with fewer hospitalized patients; however, the median cost per patient was the highest of all years, amounting to US$15,089.90 (Q1-3, US$8064.17-29102.50), while the median cost per patient from 2014 to 2019 was US$9969.96 (Q1-3, US$5177.98-21,942.68). Statistical significance was found in the median cost per patient in 2020 compared to the median cost per patient in 2014-2019 (p-value 0.019). Risk factors associated with the more expensive cost of treatment were longer length of stay (LOS); age more than 60 years old; readmission; diabetes mellitus (DM); hypertension; and heart disease. Conclusion: There were several key factors impacting the direct healthcare costs of severe MK treatment. Medical professional services emerged as the most substantial cost category, while longer hospital stays, older age groups, readmission cases, and comorbidities such as diabetes mellitus, hypertension, and heart disease were all linked to elevated treatment expenses. There were no statistically significant differences in the direct medical expenses during hospitalization associated with treating severe MK, whether the culture results were positive or negative, or regardless of the type of cultured organism utilized.

Predictive factors of development of dysthyroid optic neuropathy among individuals with thyroid-eye disease.

PURPOSE: Dysthyroid optic neuropathy (DON) is a severe visual loss condition in thyroid eye disease (TED). This study aimed to identify factors affecting moderate-to-severe TED or DON in Thai populations. METHODS: We retrospectively reviewed the records of 230 TED patients at Rajavithi Hospital between January 1, 2017, and October 31, 2022. RESULTS: Mild, moderate-to-severe TED, and DON were found in 60.43%, 22.61%, and 16.96% of participants, respectively. Female predominance was noted in all groups. The proportion of older age, hyperthyroidism, current smokers, and type 2 diabetes mellitus (T2DM) participants were significantly higher in the DON group. Multivariable logistic-regression analysis revealed that hyperthyroidism and current smoking significantly increased the risk of developing moderate-to-severe TED (OR = 3.001, p = 0.010, and OR = 4.153, p = 0.015, respectively). Exophthalmos was the strongest predictor (OR = 6.834, p < 0.001). Regarding DON risk factors, older age (≥55 years) had OR = 3.206 (p = 0.003), hyperthyroidism had OR = 3.228 (p = 0.005), and being a current smoker had OR = 3.781 (p = 0.011). T2DM posed the greatest risk of DON development (OR = 4.111, p = 0.004). CONCLUSIONS: Hyperthyroidism and current smoking are significant risk factors for moderate-to-severe TED and DON. TED patients with diabetes mellitus or older age should be closely monitored and informed about their risk of developing DON.

Estimated direct and indirect health care costs of severe infectious keratitis by cultured organisms in Thailand: An 8-year retrospective study.

PURPOSE: To evaluate the economic impact of treating severe infectious keratitis (IK) at one tertiary referral center in Thailand by analyzing the direct costs of treatment and estimating the indirect costs, and to determine whether cultured organisms had any effect on treatment expenditure. METHODS: A retrospective study was conducted of patients with severe IK who had been hospitalized between January 2014 and December 2021 in Rajavithi Hospital. Data from medical records were collected from the time of the patients' admission until the point at which they were discharged and treated in the outpatient department and their IK was completely healed, or until evisceration/enucleation was performed. The direct costs of treatment included fees for services, medical professionals and investigation, as well as for operative and non-operative treatment. The indirect costs consisted of patients' loss of wages, and costs of travel and food. RESULTS: A total of 335 patients were studied. The median direct, indirect and total costs were US$65.2, range US$ 6.5-1,119.1, US$314.5, range US$50.8-1,067.5, and US$426.1, range 57.5-1,971.5 respectively. There was no statistically significant difference between direct, indirect, or total treatment costs for culture-negative and culture-positive patients. Among those who were positive, fungal infections entailed the highest total cost of treatment, and this difference was statistically significant (p<0.001). In terms of direct and indirect costs, patients with fungal infections had the greatest direct costs, and this figure was statistically significant (p = 0.001); however, those with parasitic infections had the highest indirect treatment costs, and this was also statistically significant (p<0.001). CONCLUSION: Severe IK can cause serious vision impairment or blindness. Indirect costs represented the majority of the expense at 73.8%. There was no difference between direct, indirect, and total treatment costs for patients who were culture-negative or positive. Among the latter, fungal infections resulted in the highest total cost of treatment.

Assessing the Risk Factors For Diagnosed Symptomatic Dry Eye Using a Smartphone App: Cross-sectional Study.

BACKGROUND: Dry eye (DE) is a chronic inflammatory disease of the ocular surface of the eye that affects millions of people throughout the world. Smartphone use as an effective health care tool has grown exponentially. The "Dry eye or not?" app was created to evaluate the prevalence of symptomatic DE, screen for its occurrence, and provide feedback to users with symptomatic DE throughout Thailand. OBJECTIVE: The purpose of this study was to compare the prevalence of symptomatic dry eye (DE), blink rate, maximum blink interval (MBI), and best spectacle-corrected visual acuity (BSCVA) between people with and without symptomatic DE and to identify risk factors for symptomatic DE in Thailand. METHODS: This cross-sectional study sourced data from the "Dry eye or not?" smartphone app between November 2019 and July 2020. This app collected demographic data, Ocular Surface Disease Index (OSDI) score, blink rate, MBI, BSCVA, and visual display terminal (VDT) use data. The criterion for symptomatic DE was OSDI score ≥13. RESULTS: The prevalence of symptomatic DE among individuals using this smartphone app in Thailand was 85.8% (8131/9482), with the Northeastern region of Thailand having the highest prevalence, followed by the Northern region. Worse BSCVA (median 0.20, IQR 0.40; P=.02), increased blink rate (median 18, IQR 16; P<.001), reduced MBI (median 8.90, IQR 10.80; P<.001), female sex (adjusted OR 1.83; 95% CI 1.59-2.09; P<.001), more than 6 hours of VDT use (adjusted OR 1.59; 95% CI 1.15-2.19; P=.004), and lower than bachelor's degree (adjusted OR 1.30; 95% CI 1.03-1.64; P=.02) were significantly associated with symptomatic DE. An age over 50 years (adjusted OR 0.77; 95% CI 0.60-0.99) was significantly less associated with symptomatic DE (P=.04). CONCLUSIONS: This smartphone DE app showed that the prevalence of symptomatic DE in Thailand was 85.8%. Signs and risk factors could be also evaluated with this smartphone DE app. Screening for DE by this app may allow for the development of strategic plans for health care systems in Thailand.

Clinical evaluation of ocular biometry of dual Scheimpflug analyzer, GALILEI G6 and swept source optical coherence tomography, ANTERION.

To evaluate the performance of a new swept source optical coherence tomography optical biometer, ANTERION, in ocular biometry and intraocular lens (IOL) calculation compared with the reference standard of Dual Scheimpflug Analyzer (GALILEI, G6). A prospective comparative study was conducted in a tertiary eye center. Cataract patients were scanned with both devices in a random fashion, and parameters from the devices were analyzed in terms of mean difference and intraclass correlation coefficient (ICC). Bland-Altman plots were performed to compare agreement between the devices. Ninety-six eyes from 96 patients were enrolled for evaluation. With the exception of ACD, all parameters were significantly different, but excellent agreement was revealed for all of them. The mean difference in axial length was 0.03 mm, and ICC was 0.999. Calculated IOL power with Barrett formula revealed that 93.75% were within 1 diopter and the prediction error was 0.03 diopter. Biometry of the devices were arithmetically different. However, the mean difference of the key factors in IOL calculation were small and appeared to be negligible for the purposes of clinical application. The performance of ANTERION was comparable to that of G6 in biometric measurement and IOL calculation; however, the devices cannot be used interchangeably.

Evaluation of ocular biometry in primary angle-closure disease with two swept source optical coherence tomography devices.

PURPOSE: To investigate agreement between 2 swept source OCT biometers, IOL Master700 and Anterion, in various ocular biometry and intraocular lens (IOL) calculations of primary angle-closure disease (PACD). SETTING: Rajavithi Hospital, Bangkok, Thailand. DESIGN: Prospective comparative study. METHODS: This study conducted in a tertiary eye care center involving biometric measurements obtained with 2 devices in phakic eye with diagnosis of PACD. Mean difference and intraclass correlation coefficient (ICC) with confidence limits were assessed, and calculations of estimated residual refraction of the IOL were analysed using Barrett's formula. RESULTS: Sixty-nine eyes from 45 PACD patients were enrolled for the study. Excellent agreement of various parameters was revealed, with ICC (confidence limits) of K1 = 0.953 (0.861-0.979), K2 = 0.950 (0.778-0.98), ACD = 0.932 (0.529-0.978), WTW = 0.775 (0.477-0.888), and LT = 0.947 (0.905-0.97). Mean difference of axial length (AL) was -0.01 ± 0.02 mm with ICC of 1.000. IOL calculation was assessed with Barrett's formula, and Bland-Altman plot showed excellent agreement in the results of the 2 devices for the IOL power and estimated post-operative residual refraction (EPR). CONCLUSIONS: Mean differences of biometric parameters, obtained with IOL Master700 and Anterion, were small, and ICC showed excellent concordance. No clinical relevance in calculation of IOL power was found, and the two devices appeared to be comparably effective in clinical practice.

Microbial contamination of multiple-dose preservative-free hospital ophthalmic preparations in a tertiary care hospital.

Background: It is possible that preservative-free eye drops can be contaminated. The aim of this study was to assess the incidence of microbial contamination of preservative-free hospital-prepared anti-infective eye drops and investigate factors that contribute to contamination. This finding may help to raise awareness of this problem to medical healthcare staff and patients in order to prevent the transmission of microorganisms from eye drops to the patients through treatment of pre-existing eye diseases. Methods: Two hundred and ninety-five eye drop bottles were collected from patients attending Rajavithi Hospital Ophthalmologic outpatient and inpatient department, including both those used by patients at home and those administered in the hospital by medical staff. Samples were taken from the tips of droppers and bottles, and the residual fluid inside the bottles was then cultivated onto different culture plates. The culture results were identified and analyzed according to various factors related to both individual users and the bottles. Results: Seven different types of eye drops were collected and 71 (24.06%) of the 295 bottles were contaminated. Vancomycin eye drops were the most contaminated. Twenty-six different types of pathogens were identified, most frequently mold (42.98%), and the amount of contamination was higher in tips than in residual fluid inside the bottle. There was no statistically significant difference in contamination between patients used eye drops collected in outpatient units (32.14%) and medical staff used eye drops collected in inpatient settings (23.22%). The only factor that was statistically significant was the number of eye drops used per person. We found that samples from patients who used only up to 2 eye drops suffered contamination (42.8%) more than those from their counterparts who used at least 3 (22.18%), P â€‹= â€‹0.02. Conclusions: Of these preservative-free hospital preparations anti-infective eye drops, 24.06% were contaminated. The number of eye drops used per person was statistically significant in triggering contamination. There is a possibility of number of eyedrops use person may trigger contamination.

Economic Evaluations of Artificial Intelligence in Ophthalmology.

ABSTRACT: Artificial intelligence (AI) is expected to cause significant medical quality enhancements and cost-saving improvements in ophthalmology. Although there has been a rapid growth of studies on AI in the recent years, real-world adoption of AI is still rare. One reason may be because the data derived from economic evaluations of AI in health care, which policy makers used for adopting new technology, have been fragmented and scarce. Most data on economics of AI in ophthalmology are from diabetic retinopathy (DR) screening. Few studies classified costs of AI software, which has been considered as a medical device, into direct medical costs. These costs of AI are composed of initial and maintenance costs. The initial costs may include investment in research and development, and costs for validation of different datasets. Meanwhile, the maintenance costs include costs for algorithms upgrade and hardware maintenance in the long run. The cost of AI should be balanced between manufacturing price and reimbursements since it may pose significant challenges and barriers to providers. Evidence from cost-effectiveness analyses showed that AI, either standalone or used with humans, was more cost-effective than manual DR screening. Notably, economic evaluation of AI for DR screening can be used as a model for AI to other ophthalmic diseases.

Ocular Surface Erosion after Suspected Exposure to Evaporated COVID-19 Vaccine.

The purpose is to report ocular surface erosion of health personnel who were exposed to evaporated CoronaVac during a vaccination campaign. A campaign for CoronaVac vaccination was conducted in a closed space of 11.04 × 5.96 m, partially divided into 6 rooms with interconnected area among the rooms. A total of 20 health personnel worked in the vaccination rooms. On the third day of campaign, a vial, containing a single dose of 0.5 mL, of the vaccine was dropped accidentally onto the floor and broken by an administering nurse. A total of 15 personnel had symptoms and signs of ocular surface erosion at the average time from the accident to the onset of 10.2 ± 7.1 h; 4 personnel also had skin rash. These personnel included all 13 persons who already worked in the rooms when the accident occurred and continued for additional 4-6 h and 2 personnel who presented in the rooms 1-2 h after the accident and stayed for 2-3 h. Proximity and timing suggest CoronaVac correlation with the ocular and skin reactions. Cautions should be taken to avoid broken vials, spills, and aerosolization of CoronaVac during the vaccination.

THz imaging system for in vivo human cornea.

Terahertz (THz) imaging of corneal tissue water content (CTWC) is a proposed method for early, accurate detection and study of corneal diseases. Despite promising results from ex vivo and in vivo cornea studies, interpretation of the reflectivity data is confounded by the contact between corneal tissue and rigid dielectric window used to flatten the imaging field. This work develops a novel imaging system and image reconstruction methods specifically for nearly spherical targets such as human cornea. A prototype system was constructed using a 650 GHz multiplier source and Schottky diode detector. Resolution and imaging field strength measurement from characterization targets correlate well with those predicted by the quasioptical theory and physical optics analysis. Imaging experiments with corneal phantoms and ex vivo corneas demonstrate the hydration sensitivity of the imaging system and reliable measurement of CTWC. We present successful acquisition of non-contact THz images of in vivo human cornea, and discuss strategies for optimizing the imaging system design for clinical use.

Optical System Design for Noncontact, Normal Incidence, THz Imaging of in vivo Human Cornea.

Reflection mode Terahertz (THz) imaging of corneal tissue water content (CTWC) is a proposed method for early, accurate detection and study of corneal diseases. Despite promising results from ex vivo and in vivo cornea studies, interpretation of the reflectivity data is confounded by the contact between corneal tissue and dielectric windows used to flatten the imaging field. Herein, we present an optical design for non-contact THz imaging of cornea. A beam scanning methodology performs angular, normal incidence sweeps of a focused beam over the corneal surface while keeping the source, detector, and patient stationary. A quasioptical analysis method is developed to analyze the theoretical resolution and imaging field intensity profile. These results are compared to the electric field distribution computed with a physical optics analysis code. Imaging experiments validate the optical theories behind the design and suggest that quasioptical methods are sufficient for designing of THz corneal imaging systems. Successful imaging operations support the feasibility of non-contact in vivo imaging. We believe that this optical system design will enable the first, clinically relevant, in vivo exploration of CTWC using THz technology.

Efficacy and Safety of Hole Implantable Collamer Lens in Comparison with Original Implantable Collamer Lens in Patients with Moderate to High Myopia.

Background: Laser in situ Keratomileusis (LASIK) is the most commonly performed and widely accepted corneal refractive procedure. The Visian Implantable Collamer lens (ICL, STAAR Surgical), a posterior chamber phakic intraocular lens, has been reported to be very effective in correction of moderate to high myopia in patients who are unable to proceed with LASIK surgery due either high correction or thin cornea. A modified implantable collamer lens (ICL) with a central hole (diameter 0.36 mm), "Hole ICL", was created to improve aqueous humor circulation: not only does it make the ICL implantation feasible without prior Laser peripheral iridotomy, but it also helps to reduce the incidence of cataract formation after ICL implantation because of its resultant improvement in aqueous humor circulation behind the ICL. Objective: To evaluate the efficacy and safety of the new "Hole ICL" in comparison with conventional ICL 3 months after implantation. Material and Method: This study was a non-inferiority trial in which both ICL models, the conventional ICL (Group A) and the new Hole ICL (Group B), were studied. Patients were divided into 2 groups, each containing 60 eyes: the conventional ICL group, requiring laser peripheral iridotomy, and the new Hole ICL group. The uncorrected distance visual acuity (UDVA) log MAR and the intraocular pressure (IOP) were recorded preoperatively, and then 1 day, 1 week, 1 month and 3 months postoperatively. Spherical aberration was measured preoperatively and 3 months postoperatively. Results: The mean age in the conventional ICL group was 29.75±6.17 years (range 21-45 years), and 28.75±5.27 years (range 21-39 years) in the Hole ICL group. There was no pupillary block in either group. The UCVA log MAR in both groups showed statistically significant improvement 3 months postoperatively compared with preoperative log MAR, but there was no statistically significant difference between the log MARs of the two groups 3 months postoperatively. There was no significant change in preoperative IOP and IOP 1 day, 1 week, 1 month and 3 months postoperatively in either group, there was no difference between postoperative IOP in the two groups, and there was also no statistical significance between the spherical aberration changes in the 2 groups 3 months postoperatively. Conclusion: The two groups had similar clinical effectiveness in terms of unaided visual acuity, best corrected visual acuity, intraocular pressure and spherical aberration induction. The new Hole-ICL group (Group B) needed no preoperative laser peripheral iridotomies or intraoperative iridectomy.

Wavefront and ocular spherical aberration after implantation of different types of aspheric intraocular lenses based on corneal spherical aberration.

BACKGROUND: To determine the ocular spherical aberration after using preoperative corneal spherical aberration guided aspheric IOL selection for cataract surgery. MATERIAL AND METHOD: Twenty-six eyes of cataract patients were scheduled for cataract surgery with aspheric IOL implantation based on preoperative corneal spherical aberration (SA) measured by Galilei corneal topography. The target postoperative total wavefront spherical aberration was zero. Three types of LOL were used in this study: TecnisZA9003 (Abbott Medical Optics Inc) with spherical aberration of -0.27 microm; Acrysof LQ SN60WF (Alcon Inc.) with spherical aberration of -0.20 microm and B&L Akreos with zero spherical aberration. Ocular spherical aberration was measured with a Wave Light machine 3 months postoperatively to demonstrate the total ocular spherical aberration. RESULTS: The preoperative mean corneal spherical aberration in the 3 groups was 0.351 +/- 0.08, 0.181 +/- 0.04, and 0.056 +/- 0.03 microns respectively. All 26 eyes of 26 patients completed the 3-month follow-up visit. Postoperative ocular spherical aberration of the 3 groups were: TecnisZA9003 (10 eyes) +0.023 +/- 0.011 microm; Acrysof IQ SN60WF (11 eyes) +0.045 +/- 0.018 microm; and B&L Akreos (5 eyes) +0.018 +/- 0.008 microm. These values were significantly lower than the predicted values in the Tecnis and Akreos groups and there was no correlation between the actual postoperative ocular spherical aberration and the predicted ocular spherical aberration in all groups. CONCLUSION: The implantation of an aspheric intraocular lens based on preoperative corneal spherical aberration is effective in reducing total ocular spherical aberration and improving visual function.

Clinical evaluation of intra-bleb pigmentation after trabeculectomy: a case-control study.

OBJECTIVE: To evaluate the clinical status of a filtering bleb with visible pigment (intra-bleb pigmentation, IBP), in a case-controlled manner. MATERIAL AND METHOD: Forty-one patients with IBP and 40 patients without visible pigment in blebs (controls) were enrolled from the authors' clinic. All patients underwent either trabeculectomy alone or combined cataract extraction with intraocular lens implantation and trabeculectomy. RESULTS: Mean follow-up period was 22.8 months. Complete success (final IOP < 22 mmHg without additional treatment) was achieved more often in IBP patients (82.9%) than in controls (60%, p = 0.022). Median survival time was greater in IBP patients (49.9 +/- 0 months) than in controls (35.5 +/- 4.9 months, p = 0.013). Regression analysis revealed that IBP was associated with thin and cystic blebs (p = 0.023). Sex, age, eye, diagnosis, procedure, and mitomycin C had no effect on IBP development. IBP grading, location, and appearance did not relate to the success rate or bleb characteristics. CONCLUSION: IBP appears to be a favorable sign in filtering blebs, in terms of complete success and survival time, because IBP is associated with thin-walled blebs. Clinicians should carefully observe patients for IBP when evaluating filtering blebs.

Non-arteritic anterior ischaemic optic neuropathy associated with neovascular glaucoma.

We report a case of non-arteritic anterior ischaemic optic neuropathy (NAION) associated with neovascular glaucoma (NVG). A 63-year-old man who had undergone cataract surgery 3 months previously presented with sudden visual loss in his right eye. Ocular examination revealed a relative afferent pupillary defect, intraocular pressure (IOP) of 27 mm Hg, and 360° neovascularisation. Fundus examination revealed a pale and swollen optic disc with diabetic retinopathy. NAION associated with NVG was diagnosed. NVG, leading to reduced optic nerve perfusion pressure, concurrent with ischaemic processes of diabetic retinopathy, resulted in NAION.