The Narrow-Lumen Jones Tube: A Novel Approach to Dry Eye Following Conjunctivodacryocystorhinostomy.

Conjunctivodacryocystorhinostomy with placement of a Jones tube (JT) is the gold standard for upper lacrimal system dysfunction. However, traditional JT have been associated with various complications. In their practice, the authors have encountered challenges with postoperative dry eye in a select group of patients, with recurrence of epiphora following tube occlusion, suggesting a need for decreasing the rate of tear drainage while maintaining a patent JT. To address this issue, the senior author (J.D.N.) introduced a modified JT with a narrow lumen (reduced-flow JT) for patients who experience significant dry eye symptoms after placement of a JT. The authors describe 3 patients who experienced improvement in dry eye symptoms after the placement of reduced-flow JT.

Clinical Documentation in Electronic Health Record Systems: Analysis of Similarity in Progress Notes from Consecutive Outpatient Ophthalmology Encounters.

Content importing technology enables duplication of large amounts of clinical text in electronic health record (EHR) progress notes. It can be difficult to find key sections such as Assessment and Plan in the resulting note. To quantify the extent of text length and duplication, we analyzed average ophthalmology note length and calculated novelty of each major note section (Subjective, Objective, Assessment, Plan, Other). We performed a retrospective chart review of consecutive note pairs and found that the average encounter note was 1182 ± 374 words long and less than a quarter of words changed between visits. The Plan note section had the highest percentage of change, and both the Assessment and Plan sections comprised a small fraction of the full note. Analysis of progress notes by section and unique content helps describe physician documentation activity and inform best practices and EHR design recommendations.