Chronic Eye Research Articles

Effects of Animation and Rotoscoping In Direct-to-Consumer Rx TV Advertising

This study experimentally tested the effects of animation versus rotoscoping versus live action in direct-to-consumer television advertising on outcomes, including risk and benefit perceptions and attitudes toward the drug. The authors used an online panel to recruit participants with chronic dry eye (<i>n</i> = 504) and psoriasis (<i>n</i> = 490). The study found no effects of animation or rotoscoping on perceptions of drug risk or benefit, comprehension, or behavioral intentions. Animated advertisements, however, resulted in more negative attitudes than live-action or rotoscoped advertisements. Future research should explore whether animated advertisements are recalled better over time or have any lagged effects on perceptions.

Glaucoma Assessment from Fundus Images with Fundus to OCT Feature Space Mapping

Early detection and treatment of glaucoma is of interest as it is a chronic eye disease leading to an irreversible loss of vision. Existing automated systems rely largely on fundus images for assessment of glaucoma due to their fast acquisition and cost-effectiveness. Optical Coherence Tomographic ( OCT ) images provide vital and unambiguous information about nerve fiber loss and optic cup morphology, which are essential for disease assessment. However, the high cost of OCT is a deterrent for deployment in screening at large scale. In this article, we present a novel CAD solution wherein both OCT and fundus modality images are leveraged to learn a model that can perform a mapping of fundus to OCT feature space. We show how this model can be subsequently used to detect glaucoma given an image from only one modality (fundus). The proposed model has been validated extensively on four public andtwo private datasets. It attained an AUC/Sensitivity value of 0.9429/0.9044 on a diverse set of 568 images, which is superior to the figures obtained by a model that is trained only on fundus features. Cross-validation was also done on nearly 1,600 images drawn from a private (OD-centric) and a public (macula-centric) dataset and the proposed model was found to outperform the state-of-the-art method by 8% (public) to 18% (private). Thus, we conclude that fundus to OCT feature space mapping is an attractive option for glaucoma detection.

Study of the effectiveness of osteopathic correction in the complex treatment of patients with operated primary open-angle glaucoma

Introduction. Glaucoma is a chronic eye disease characterized by a constant or periodic increase in intraocular pressure, a decrease of visual fields and visual acuity, and by a special form of optic nerve atrophy with excavation in the disc area. The reflection of this slowly fl owing atrophy is a disturbance in the visual field and a complete irreversible loss of visual function. The prevalence of the disease increases with increasing age. The main methods of treatment are medical and surgical. Non-penetrating operations are recognized as the safest methods of surgical treatment of glaucoma. The most common complications of such operations include: detachment of the choroid, small anterior chamber syndrome, hyphema, cicatricial changes in the filtration cushion. Based on the analysis of literature data, it can be assumed that the inclusion of osteopathic correction in the complex therapy of patients with operated glaucoma can increase the effectiveness of therapy.The aim of the research was to study the clinical efficacy of osteopathic correction in the complex treatment of patients operated on primary open-angle glaucoma.Materials and methods. The study involved 20 patients (20 eyes) aged 70 to 75 years with developed and advanced stages of primary open-angle glaucoma, who underwent surgical treatment. The main (10 people) and control (10 people) groups were formed by simple randomization. Participants in the main group received standard medical therapy and osteopathic correction, while participants in the control group received only medical therapy. Changes in the following clinical parameters were evaluated: visual acuity, visual fi eld, intraocular pressure, thickness of the retinal nerve fiber layer, and severity of pain syndrome. Indicators were recorded at the beginning of the study (2 weeks after surgery) and at the end of the study (2–3 months after surgery).Results. Patients receiving osteopathic correction as part of the complex therapy after surgery of primary openangle glaucoma are characterized by a statistically significant (p&lt;0,05) decrease in the severity of pain syndrome, an increase in the magnitude of the visual field and of the thickness of the retinal nerve fiber layer.Conclusion. The obtained results suggest the effectiveness of the inclusion of osteopathic correction in the complex treatment of patients with operated on primary open-angle glaucoma. It is recommended to continue the study with a larger sample size.

Amniotic membrane extract eye drops: a new approach to severe ocular surface pathologies.

A protocol for processing amniotic membrane as an extract to be re-hydrated and administered topically as eye drops (amniotic membrane extract eye drops, AMEED) has been developed. Safety and efficacy of AMEED was assessed in patients with severe ocular surface pathologies. prospective clinical follow-up of ocular surface symptoms before and after regular application of the AMEED for at least 4weeks on patients with severe ocular surface disorders as chronic dry eye disease, limbal stem cell deficiency, neurotrophic ulcer and permanent and disabling symptomatology that were refractory to conventional treatment. Efficacy and tolerability were assessed based on patient-reported symptoms, objective measurements, and reports of adverse events. Thirty-six eyes from 25 patients were included. Although the visual quality function score, by means of a VQF25 questionnaire, was not statistically different after the treatment (p = 0.4657), there was a clear trend, statistically significant, towards the improvement in ocular symptoms like foreign body sensation, itching and stinging (p < 0.05) and clinical presentation of the pathology. All patients with corneal ulcer showed complete epithelization. Topically applied AMEED proved to be safe, well tolerated and effective in reducing the symptoms and clinical signs of severe ocular disease. Further studies are needed to confirm the best indications for AMEED use.

Einstellung von Patienten zu möglicher Telemedizin in der Ophthalmologie

HintergrundDie COVID-19-Pandemie im Jahr 2020 und 2021 schränkt die Versorgung augenärztlicher Patienten vielfach ein. Teleophthalmologische Leistungen wie Videokonsultation oder medizinische Telefonberatungen könnten den Mangel an notwendigen Kontrollen bei chronischen Erkrankungen, zumindest teilweise, kompensieren. Teleophthalmologische Angebote sind jedoch in Deutschland aktuell noch deutlich unterrepräsentiert.Ziel der ArbeitUm die Bereitschaft auf Patientenseite zur Telemedizin und virtuellen Klinik zu ermitteln, führten wir bei Patienten der Hochschulmedizin mit bekanntem Glaukom als chronische Erkrankung eine Umfrage mittels Fragebogen während der ersten Welle der COVID-19-Pandemie zum Thema Teleophthalmologie durch.MethodenEs wurden 100 Patienten befragt. Der Fragenkatalog beinhaltete 22 Fragen mit Mehrfachwahl-Antwortmöglichkeiten. Als Einschlusskriterium galten das Vorhandensein eines Glaukoms als chronische Erkrankung, Alter über 18 Jahre sowie eine ausreichende sprachliche Verständigung zur Beantwortung der Fragen. Die Daten wurden anonymisiert erhoben, analysiert und ausgewertet.ErgebnisseIn der Patientenumfrage konnte aufgezeigt werden, dass eine hohe Bereitschaft zur Teleophthalmologie bei den Befragten im Bereich des Glaukoms als chronische Erkrankung vorhanden ist und diese in Anspruch genommen werden würde; 74,0 % der Befragten würden Telemedizin und virtuelle Kliniken akzeptieren; 54,0 % der Befragten ophthalmologischen Patienten gab an, dass ihr Arzt‑/Klinikbesuch aufgrund von SARS-CoV‑2 nicht stattfinden konnte; 17,0 % der Patienten gaben an, dass sich durch die SARS-CoV-2-Pandemie ihre Meinung gegenüber der Telemedizin geändert hat.DiskussionDie Akzeptanz der Patienten für Telemedizin bei Patienten mit chronischem Offenwinkelglaukom scheint erstaunlich hoch. Diese ist durch die SARS-CoV-2-Pandemie noch weiter gesteigert worden. Diese Ergebnisse spiegeln eine generelle Bereitschaft bei Patienten mit chronischer Augenerkrankung wider, reflektieren jedoch nicht die Anwendbarkeit sowie die Akzeptanz aus ärztlicher Sicht. Diese Form der virtuellen Konsultation findet jedoch bei einem Großteil der Patienten mit Glaukom Akzeptanz und könnte überdacht werden.

Ophthalmologists perceived usefulness of Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) for evaluating the mental health of patients with chronic eye diseases.

To evaluate the awareness of ophthalmologists about assessing the mental health of patients and usefulness of the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD-7) survey. This web-based survey was performed in 2020 at an eye hospital in Saudi Arabia. Participants included ophthalmologists and physicians. Participants were queried on the need to assess mental health of patients, usefulness of the screening tool, and barriers to assessment. Their responses were graded on a Likert scale and Rasch analysis was performed. Of the 100 participants, 72 were aware of assessing mental health of eye patients and 82 expressed about limited skills for such assessment. The median score for perceived usefulness of the PHQ-9 as screening tool to suspect depression was -1.0 (inter quartile range, -1.0: 0.0) [Mean Rasch score = -0.735]. The median score of perceived usefulness for the GAD-7 as screening tool to suspect anxiety was -1.0 (inter quartile range, -1.0: 0.0) [Mean Rasch score = -0.695]. The PHQ-9 related score was significantly correlated to "30-39 years" age group (Kruskal Wallis p = 0.04) and non-Saudi professionals (Mann Whitney p = 0.005). The GAD-7 related score was significantly correlated to non-Saudi professionals (Mann Whitney p = 0.04). The mental health related score was significantly and negatively correlated to the "40-59 years" age group (Kruskal Wallis p = 0.04). Although awareness of mental health assessment was high, eyecare professionals felt with inadequate training for performing the screening. PHQ-9 seems to be more acceptable to screen for depression than GAD-7 for screening anxiety.

Quality of Life in Patients with Chronic Thyroid Eye Disease in the United States.

IntroductionThyroid eye disease (TED) is an autoimmune condition producing ocular pain, dysmotility, and ocular structure and function changes. As disease activity changes, redness, swelling, and pain can improve, but eye comfort, appearance, and motility alterations often persist. There are limited data on chronic TED patient-reported outcomes. This study examined chronic US TED patient-reported symptoms and quality of life (QOL).MethodsExisting data from an online survey regarding chronic TED signs/symptoms and patient QOL were retrospectively examined. The Graves’ Ophthalmopathy QOL instrument (GO-QOL; 0–100, 100 = highest QOL) evaluated overall, appearance, and vision-related QOL. Influencing factors were examined by stratifying patients into low (overall QOL ≤ 50), moderate (> 50 and < 75), and high (≥ 75) QOL categories.ResultsOne hundred patients (47 women, 81 Caucasian, 45.2 ± 7.6 years) were included. The duration of inactive TED was 3.0 ± 4.6 years and total duration of TED was 5.8 ± 5.9 years. Patients reported an average of 20 doctor visits/year and high prevalence of anxiety (34%) and depression (28%). Prior TED treatments for the polled population included systemic corticosteroids during active TED (25%), orbital radiation (5%), and surgery (25%). The overall GO-QOL score was 60.5 ± 21.8 (vision-related: 58.6 ± 24.0, appearance-related: 62.3 ± 25.1). Patients with low QOL more frequently reported hypothyroidism, anxiety, and a larger number of chronic TED signs/symptoms (average: 4.2). Compared to high QOL patients, low QOL patients had more pain (39% vs. 13%), blurry vision (30% vs. 17%), and diplopia (27% vs. 3%, all p ≤ 0.025). Additionally, the low QOL group more often had TED-specific surgical history (45% vs. 10%, p = 0.002), more often reported disability/unemployment (21% vs. 3%, p = 0.055), and had a higher number of doctor visits (40 vs. 5 visits/person/year, p < 0.001).ConclusionTED severely impacts patient QOL, despite becoming stable and chronic. Patients reported vision and appearance impairment and psychosocial impact long after acute TED had subsided.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-021-00385-8.

Review of referrals reveal the impact of referral content on the triage and management of ophthalmology wait lists

ObjectivesMany chronic eye conditions are managed within public hospital ophthalmology clinics resulting in encumbered wait lists. Integrated care schemes can increase system capacity. In order to direct implementation of a...

Awareness and Attitudes Toward Cornea Donation in a Turkish Population: A Web-Based Survey.

With low supply and high demand for donor corneas, we surveyed Turkish participants on level of knowledge, awareness, and willingness toward cornea donation. Our prepared internet-based questionnaire on awareness and attitudes toward cornea donation was structured into 6 parts (parts 1-2 examined socio-demographic data and existing chronic eye diseases, parts 3-4 evaluated level of knowledge on cornea donation and willingness to donate, parts 5-6 questioned whether level of cornea donation was sufficient within the country). For univariate analyses, the chi-square test (Fisher exact where appropriate) was used. We used stepwise logistic regression analyses to evaluate factors associated with willingness to donate (α = 0.05). Of 2301 surveyed participants, 980 (42.6%) claimed to have knowledge on cornea donation/ - transplantation, with 1297 (56.4%) having willingness toward donation. Bachelor level or higher education (odds ratio = 1.33, 95% CI, 1.10-1.61; P = .004); being a health care professional (odds ratio = 1.55, 95% CI, 1.21-1.97; P = .001), university student (odds ratio = 1.53, 95% CI, 1.25-1.87; P < .001), or artist professional (odds ratio = 5.25, 95% CI, 1.12-24.6; P = .05); presence of chronic eye disease (odds ratio = 1.22, 95% CI, 1.03-1.45; P = .02); and self-reported awareness of donation/transplantation (odds ratio = 2.14, 95% CI, 1.78-2.58; P < .001) were independently associated with willingness to donate. The major disclosed reason for unwillingness was "lack of knowledge" (48.5%, n = 269); the 2 most common self-perceived reasons for negative public attitudes toward cornea donation were "lack of knowledge" (84.8%, n = 1948) and "religious and cultural reasons" (55.8%, n = 1283). Associations between both higher education and self-reported knowledge and willingness to donate are testaments that community education can help alleviate unrealistic concerns and prejudices toward cornea donation and hence improve availability of donor corneas.

Repurposing of nifedipine loaded in situ ophthalmic gel as a novel approach for glaucoma treatment

Glaucoma is a chronic eye disease characterized by elevated intraocular pressure (IOP) which causes severe complications to the eyes and may lead to vision loss. The effective treatment of such diseases motivated the search for novel and unique drugs and delivery systems. It has been reported that, nifedipine (NF) is effective in reducing the elevated IOP due to vasodilatation of eye vascular smooth muscles. NF loaded thermo-sensitive in situ gels were prepared by the cold method using poloxamer 407 (P407) and hydroxypropyl methyl cellulose (HPMC) polymers adopting Box-Behnken experimental design. All the prepared formulae were tested for homogeneity, clarity, pH, isotonicity, gelling capacity, rheological behavior, in vitro drug release and were tested in vivo on rabbits. The prepared in situ gels were homogenous, transparent, having a pH ranged from 5 to 5.5 and undergo sol-gel transition within few seconds physiological temperature. The in situ gels showed sustained in vitro release of NF where about 76% of the loaded drug was released over 12 h. NF loaded in situ gels showed a 45.83 ± 2.91% reduction in the IOP, with no sign of toxicity or irritation to the eye in rabbits. The current investigations clarified the efficiency of this novel and unique NF loaded in situ gel for the control of the IOP compared to the conventional ophthalmic dosage forms.

Comparison of Pregabalin and Placebo Effects in Treating Eye Pain Following Cataract Surgery by Phacoemulsification Method

Cataract surgery sometimes is associated with adverse effects, such as dryness, burning, and patient discomfort. This study evaluates the treatment of dry eye syndrome and pain caused by corneal damage following cataract surgery with pregabalin compared to placebo. In our double-blind clinical trial, a total of 60 cases were divided into two groups. The pain score was assessed by the Numeric Rating Scale (NRS), and the impact of pain and dryness on the patient's performance was evaluated by the Brief Pain Inventory (BPI). The patient's pain score was evaluated postoperatively and followed for six weeks after the procedure. After the sixth week of the study, NRS, BPI, and photophobia in the pregabalin group were significantly different from the placebo group. Pregabalin can significantly reduce chronic and resistant eye pain after cataract surgery.

Habitual fixation in monocular esotropia (ET) does not alter properties of the horizontal rectus extraocular muscles (EOMs)

Chronic eye misalignments have been supposed to induce morphologic changes in rectus EOMs. We used orbital magnetic resonace imaging (MRI) to quantify horizontal EOM morphology in patients with long-standing monocular ET.

MEASUREMENT OF RADIATION DOSE TO THE EYE LENS IN NON-ENHANCED CT SCANS OF THE BRAIN.

Radiation can have undesirable effects on the eye, including a gradual loss of vision. Unnecessary radiation can reach the eye lens during non-enhanced computed tomography (CT) scans of the brain. The International Commission on Radiological Protection states the threshold for acute and chronic eye lens exposure is 500mGy and the equivalent dose limit for the eye lens for public exposure is 15mSv per year. Therefore, we measured the direct radiation dose to the eye lens during head CT scans using NanoDots in 216 adults. The mean absorbed dose to both eyes was 33.62mGy (standard deviation ±12.442). The averages for the other variables were: tube current-time product: 260 mAs; dose-length product: 708mGycm and CT dose index: 35.5mGy. Our findings encourage further study of radiation exposure and modifications in CT imaging protocols.

In vitro Evaluation of a Hypobromous Acid Hygiene Stabilized Solution in the Reduction of Bacterial Load Associated to Blepharitis Conditions

Aims: Blepharitis is a chronic inflammation of the periocular skin area and it is characterized by eye itching, burning, dryness and irritation, with progression to chronic dry eye syndrome, where the eyelids margins of blepharitis patients are frequently colonized by bacteria. The aim of the present study was to investigate the in vitro bactericidal activity (BA) of a stabilized active bromine solution (MDI-102) at neutral pH for the potential use in the treatment and prevention of blepharitis. Methods and Results: The kinetic experiments have been conducted both in clean and in dirty conditions (by using bovine albumin solution as the interfering substance) at different ranges of concentration. The results show the topical solution to be capable of inactivating, in less than 0.5 minutes, more than 99.9% of several bacterial species involved in the clinical manifestations of blepharitis: Enterococcus hirae, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, and Serratia marcescens. Dirty condition tests confirm the results shown without albumin (clean conditions). Conclusions: MDI-102 is considered not irritating and dermatologically tested. This study demonstrates that MDI-102 active bromine solution can markedly reduce (in vitro) the bacterial activity, responsible of clinical manifestation of blepharitis. Thus, MDI-102 can be considered a promising tool for the periocular area and eyelids cleaning for blepharitis patients. Significance and Impact of the Study: The use of this formulation may contribute in the long-term prevention and hygienic treatment of blepharitis condition. Furthermore, MDI-102 can be considered as an alternative to reduce the use and the abuse of topical antibiotics in the daily practice, which may contribute to the increase of resistance to the antibiotics in the clinical setting.

Teprotumumab for the treatment of chronic thyroid eye disease

BackgroundTeprotumumab, a novel IGF-1R antibody was recently shown to significantly reduce the signs of active Thyroid eye disease (TED). The current study reviews its efficacy in chronic TED.MethodsIn this retrospective review, consecutive patients with chronic stable TED (>2 years), who had received ≥3 infusions of teprotumumab were included. All patients had measurements of proptosis, and calculation of the CAS and diplopia scores before and after therapy. Five-point strabismus scores were also calculated. Patients who had imaging within 4 months prior to therapy and 6 weeks post therapy underwent orbital 3D volumetric analysis.ResultsThirty-one patients met the inclusion criteria. The mean (SD) duration of TED was 81 months (56) and the mean (SD) number of infusions received by each patient was 7 (2). Mean (SD) reduction in proptosis for each study orbit was 3.5 mm (0.4) and 3 mm (0.3) for the fellow orbit. The CAS response was 90% for the study orbit and 87% for the fellow orbit. Of the 15 patients who had diplopia at baseline, 67% had a clinically significant response, while 47% had complete resolution following treatment. Following teprotumumab, mean (SD) reduction of muscle tissue was 2011 mm3 (1847) in the study orbit and 1620 mm3 (1759) in the fellow orbit. The mean (SD) reduction of fat volume was 2101 mm3 (1681) in the study orbit and 1370 mm3 (1181) in the fellow orbit.ConclusionTeprotumumab significantly reduces proptosis, inflammation, diplopia, strabismus and orbital soft tissue volume in patients with chronic TED.

Impact of neovascular age-related macular degeneration: burden of patients receiving therapies in Japan

The chronic eye disorder, neovascular age-related macular degeneration (nAMD), is a common cause of permanent vision impairment and blindness among the elderly in developed countries, including Japan. This study aimed to investigate the disease burden of nAMD patients under treatment, using data from the Japan National Health and Wellness surveys 2009–2014. Out of 147,272 respondents, 100 nAMD patients reported currently receiving treatment. Controls without nAMD were selected by 1:4 propensity score matching. Healthcare Resource Utilisation (HRU), Health-Related Quality of Life (HRQoL), and work productivity loss were compared between the groups. Regarding HRU, nAMD patients had significantly increased number of visits to any healthcare provider (HCP) (13.8 vs. 8.2), ophthalmologist (5.6 vs. 0.8), and other HCP (9.5 vs. 7.1) compared to controls after adjusting for confounding factors. Additionally, nAMD patients had reduced HRQoL and work productivity, i.e., reduced physical component summary (PCS) score (46.3 vs. 47.9), increased absenteeism (18.14% vs. 0.24%), presenteeism (23.89% vs. 12.44%), and total work productivity impairment (33.57% vs. 16.24%). The increased number of ophthalmologist visits were associated with decreased PCS score, increased presenteeism and total work productivity impairment. The current study highlighted substantial burden for nAMD patients, requiring further attention for future healthcare planning and treatment development.

Cascade of Inflammatory, Fibrotic Processes, and Stress-Induced Senescence in Chronic GVHD-Related Dry Eye Disease.

Ocular graft-versus-host disease (GVHD) is a major complication after allogeneic hematopoietic stem cell transplantation. Ocular GVHD affects recipients’ visual function and quality of life. Recent advanced research in this area has gradually attracted attention from a wide range of physicians and ophthalmologists. This review highlights the mechanism of immune processes and the molecular mechanism, including several inflammation cascades, pathogenic fibrosis, and stress-induced senescence related to ocular GVHD, in basic spectrum topics in this area. How the disease develops and what kinds of cells participate in ocular GVHD are discussed. Although the classical immune process is a main pathological pathway in this disease, senescence-associated changes in immune cells and stem cells may also drive this disease. The DNA damage response, p16/p21, and the expression of markers associated with the senescence-associated secretory phenotype (SASP) are seen in ocular tissue in GVHD. Macrophages, T cells, and mesenchymal cells from donors or recipients that increasingly infiltrate the ocular surface serve as the source of increased secretion of IL-6, which is a major SASP driver. Agents capable of reversing the changes, including senolytic reagents or those that can suppress the SASP seen in GVHD, provide new potential targets for the treatment of GVHD. Creating innovative therapies for ocular GVHD is necessary to treat this intractable ocular disease.

Teprotumumab for chronic thyroid eye disease

ABSTRACT Purpose To describe the treatment of nine patients with chronic, low clinical activity score thyroid eye disease with teprotumumab. Methods A retrospective series of patients with chronic thyroid eye disease (TED) and low clinical activity score (CAS) treated with teprotumumab infusion therapy. Inclusion criteria: adults over 18 years of age with TED for greater than 9 months and CAS of 1 or less. All patients included in the analyses completed a full series of eight infusions. Primary outcome measures included proptosis and eyelid retraction in both eyes. Secondary outcomes included CAS, reported adverse effects, and surgery post-treatment. Results Nine patients met all inclusion criteria, seven females and two males with mean age of 50.2 years and TED diagnosis of 6.25 years. Three patients had a baseline CAS of 1 and 6 had a CAS of 0. Mean proptosis reduction in the worse eye was 4.0 ± 2.4 mm immediately post-treatment (p = .02). Five out of nine patients had extended follow-up (average 16.8 ± 5.1 weeks) with mean proptosis reduction of 4.2 ± 2.8 mm at last follow-up (p = .03). Mean reduction in eyelid retraction in the worse eye was 0.3 ± 1.6 mm post-treatment (p = .58) and 0.5 ± 0.9 mm at last follow-up (p = .30). Three patients reported infusion-related myalgias, two hair thinning, one exacerbated chronic tinnitus, and one hyperglycemia. Conclusions We report clinically and statistically significant proptosis reduction in nine patients with chronic, low CAS TED treated with teprotumumab. Teprotumumab may be an effective treatment option for these patients.

431-P: Gaps in Retinal Screening among Medicaid Patients with Diabetes: A Natural Experiment for Translation in Diabetes (NEXT-D) 2 Study

Background: Medicaid patients face many challenges in diabetes treatment and have higher rates of complications, including diabetic retinopathy (DR). We evaluated eye exam rates over a seven year period among Medicaid patients with diabetes and assessed variation by state, Medicaid eligibility category, and race/ethnicity. Methods: Using United Healthcare claims (eligibility, medical, pharmacy) and lab data, we identified Medicaid patients with diabetes &amp;gt;21 years of age who received care in practices with &amp;gt;1000 Medicaid patients between 2010-2016. Diabetes was defined by diagnostic codes, AIC &amp;gt; 6.5% and/or anti-glycemic medication prescriptions. DR was defined by diagnostic codes. We used serial cross sections to calculate annual eye exam frequencies and our logistic regression covariates included age group, gender, race/ethnicity, language, Medicaid program, common comorbidities, indicators for type 1 vs. type 2 DM, indicators for chronic eye disease, state and and state by year fixed effects. We also adjusted for clustering at the 3-digit zip code level and excluded states with vision care carve-outs. Results: Among 160,108 Medicaid person-years with diabetes, overall unadjusted rates of annual eye exams ranged between 23-36% per year. Adjusted annual eye exam rates varied significantly between states (range: TN at 24%, NV at 44%,). Adjusted rates were also significantly higher in 2014-2016 (30-33%) as compared to the baseline rate in 2010 (26%) and among patients with chronic eye disease as compared to those without (53% vs. 22%). There were no significant differences in eye exam rates by race/ethnicity or Medicaid program. Conclusions: The majority of Medicaid patients with diabetes in our study did not receive annual eye exams between 2010-2016. These findings highlight significant gaps in care and interventions are needed to increase adherence to DR screening for underserved Medicaid patients with diabetes. Disclosure T. Moin: None. J. Harwood: None. L. Daskivich: None. J. Quinton: None. A. Vasilyev: None. N. Turk: None. O. Duru: None. C. Mangione: None. Funding Centers for Disease Control and Prevention; National Institute of Diabetes and Digestive and Kidney Diseases (U18DP006128)

Effects of Mechanical Compression on Cell Morphology and Function in Human Corneal Fibroblasts

ABSTRACT Purpose: To explore the effect of mechanical compression (similar to that induced by eye rubbing) on cell morphology, proliferation, apoptosis, and extracellular matrix synthesis and degradation in human corneal fibroblasts. Materials and methods: Human corneal fibroblasts were isolated from corneal lenticule tissue of 10 patients after small incision lenticule extraction surgery. A system was established to mechanically compress corneal fibroblasts with pressure ranging from 0 to 524 Pa. Morphological changes, cell proliferation, apoptosis, and corneal matrix synthesis and degradation were examined using microscopy imaging, bromodeoxyuridine staining, flow cytometry, and qPCR analysis in human corneal fibroblasts after mechanical compression. Results: Human corneal fibroblasts showed short and thick cytoplasmic extensions, as well as a relatively low aspect ratio, suggesting significant morphological alterations caused by high levels of compressive stress. Mechanical compression inhibited cell proliferation and promoted cell apoptosis. Furthermore, compressive stress led to significant elevation in the expression of genes related to extracellular matrix degradation (matrix metalloproteinases MMP1 and MMP9) as early as 6 h after compression and moderate changes in the expression of tissue inhibitors of metalloproteinases. In addition, the mRNA expression levels of COL1A1, lumican, and vimentin were reduced 24 and 48 h after mechanical compression. Conclusions: Mechanical compression alters cell morphology, inhibits proliferation, induces apoptosis, upregulates genes related to extracellular matrix degradation, and downregulates corneal structural genes in human corneal fibroblasts. This study provides evidence that compressive stress significantly influences corneal keratocytes. Our findings suggest that this mechanical effect may be related to keratoconus associated with chronic eye rubbing.