Development of Screening Criteria for Retinopathy of Prematurity in Ulaanbaatar, Mongolia, Using a Web-based Data Management System.

PURPOSE: To describe a process for identifying birth weight (BW) and gestational age (GA) screening guidelines in Mongolia. METHODS: This was a prospective cohort study in a tertiary care hospital in Ulaanbataar, Mongolia, of 193 premature infants with GA of 36 weeks or younger and/or BW of 2,000 g or less) with regression analysis to determine associations between BW and GA and the development of retinopathy of prematurity (ROP). RESULTS: As BW and GA decreased, the relative risk of developing ROP increased. The relative risk of developing any stage of ROP in infants born at 29 weeks or younger was 2.91 (95% CI: 1.55 to 5.44; P < .001] compared to older infants. The relative risk of developing any type of ROP in infants with BW of less than 1,200 g was 2.41 (95% CI: 1.35 to 4.29; P = .003] and developing type 2 or worse ROP was 2.05 (95% CI: 0.99 to 4.25; P = .05). CONCLUSIONS: Infants in Mongolia with heavier BW and older GA who fall outside of current United States screening guidelines of GA of 30 weeks or younger and/or BW of 1,500 g or less developed clinically relevant ROP. [J Pediatr Ophthalmol Strabismus. 2020;57(5):333-339.].

Diagnosis and management of strabismus using telemedicine.

This study was undertaken to measure the effect of telemedicine consultation for diagnosis and treatment planning in cases of strabismus. Telemedicine consultation records of all patients on ORBIS Telemedicine Cyber-Sight that resulted in a final diagnosis of superior oblique palsy (SOP), Duane syndrome (DS), and Brown syndrome (BS) were collected. The following were then determined: (1) the clinical characteristics of patients in each category, (2) the diagnosis submitted by the doctor requesting consultation compared to the diagnosis determined by the mentor, and (3) the treatment plan submitted with the consultation request compared to the mentor's suggested plan. The clinical characteristics of patients with SOP, DS, and BS were similar to those reported in the literature. There were 89 with SOP, 131 with DS, and 50 with BS. Partners and mentors agreed on the diagnosis of SOP in 81% of cases, DS in 79% of cases, and BS in 72% of cases. Mentors agreed with the partners' proposed treatment plan in SOP 35%, DS 55%, and BS 52%. Mentors are likely to change the diagnosis proposed by doctors seeking consultation for strabismus in 25% of cases and provide a new treatment plan in more than 50% of cases. The clinical characteristics of those strabismus entities selected matched those found in the literature, making it likely that the cases as viewed on telemedicine presented a true clinical picture.

Comparing immersion ultrasound with partial coherence interferometry for intraocular lens power calculation.

BACKGROUND AND OBJECTIVE: To compare the utility and accuracy of high-precision immersion ultrasound, partial coherence interferometry, and the IOL Master system (Carl Zeiss Meditec, Dublin, CA) in a tertiary care referral center. PATIENTS AND METHODS: Comparative clinical study in a tertiary care, multispecialty, university practice. Participants were consecutive patients scheduled for cataract surgery at Emory Eye Center. Patients underwent biometry using immersion ultrasound, partial coherence interferometry, and the IOL Master system. RESULTS: Twenty-two percent of eyes undergoing surgery could not be measured using interferometry. In those eyes measurable by both methods, there was no difference in measurements nor postoperative refractive outcome. Each method had a high repeatability (intraclass correlation coefficient > 0.99) with a high intraclass correlation between methods (intraclass correlation coefficient = 0.99). CONCLUSIONS: When it can be used, interferometry is equivalent to immersion ultrasonography regarding biometric accuracy and precision. However, it cannot replace ultrasonography, especially for eyes with dense media opacity.

The resident surgeon phacoemulsification learning curve.

OBJECTIVES: To analyze outcomes of resident-performed phacoemulsifications and to assess the resident phacoemulsification learning curve. METHODS: Retrospective chart review of resident-performed phacoemulsification cases at the Atlanta Veterans Affairs Medical Center, Decatur, Georgia, from July 1, 1999, through June 30, 2002. Outcomes measured included postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), intraoperative complications, and adjusted phacoemulsification times (total phacoemulsification time multiplied by phacoemulsification power used). RESULTS: We analyzed 680 cases. Postoperative mean UCVA was 20/39, and mean BSCVA was 20/25 (> or = 20/20 in 44.0% of cases and > or = 20/40 in 97.8%). There were no differences in visual acuity outcomes over the course of residency training. Intraoperative complications occurred in 34 cases (5.0%), with a significant reduction in vitreous loss rates after the first 80 resident cases (5.1% vs 1.9%; P = .03). Mean adjusted phacoemulsification time was 0.68 minutes, with a significant reduction in adjusted phacoemulsification time after the first 80 cases (0.87 vs 0.52 minutes; P < .001). CONCLUSIONS: Quality visual outcomes after phacoemulsification can be attained throughout residency training; however, surgical competency, when measured by complication rates and phacoemulsification efficiency, continues to improve significantly with increasing surgical experience well beyond the first 80 resident phacoemulsification cases.