Consultant Ophthalmologist Research Articles

Which glaucoma patients should be monitored at home and exploration of clinician perceptions on home monitoring? a survey of glaucoma specialists in the UK

ObjectivesTo identify suitable patients for glaucoma home monitoring and explore clinicians’ perceptions of the possible benefits and risks of home monitoring within the National Health Service.DesignAn online survey composed of open-ended and closed-ended questions.SettingSecondary care.ParticipantsGlaucoma specialists registered with the UK and Eire Glaucoma Society.Outcome measuresAgreement with clinical scenarios.ResultsThe estimated response rate was 68% (n=49). Of 49 participants, 92% (n=45) were consultant ophthalmologists and 71% (n=35) had over 10-year experience. There was a poor agreement regarding an ideal glaucoma patient for home monitoring, with only one scenario achieving over 60% agreement. Most participants believed that home monitoring would be most suitable for low-risk scenarios, rather than high-risk, due to fear of missing progression. In relation to acceptability, key facilitators included the potential to increase healthcare capacity and promote patient safety. However, low clinician trust in equipment reliability and fear of patient harm were reported as concerns.ConclusionsThere was no clear consensus on which patients would benefit most from glaucoma home monitoring. While many clinicians believe home monitoring may enhance healthcare, there were also many concerns about the technologies themselves. Further work to address clinician concerns is warranted.Research Registry registration number6213.

Hospital to community in Wales: What is the value of optometrists playing a greater role in managing neovascular AMD and glaucoma in primary care?

To evaluate the value of enhanced optometric services for managing neovascular age-related macular degeneration (nAMD) and glaucoma in primary care optometry services, instead of hospital eye services (HES). Seven enhanced optometric service pathways in primary care in Wales were assessed with a mixed-methods approach: three for nAMD and four for glaucoma. The methods were a patient-related experience measure (PREM), a Realist Review and Evaluation involving both patients and staff, a discrete event simulation model estimating the economic impact of the pathways and a workforce survey of optometrists to gauge capability and capacity. Patient-related experience measure responses (802) indicated that primary care experience was comparable to that of HES. Utilising enhanced optometric services in primary care resulted in reduced wait times compared with HES, with suspected nAMD shortened to 4-5 days and glaucoma monitoring to 5 days. Waiting lists were dramatically reduced with primary care-based services to just three people waiting for nAMD and five for glaucoma, compared with 216 and 5691 people, respectively, in HES. Consultant ophthalmologist time was reduced from 57% to 15%-16% for nAMD services and from 48% to 22%-23% for glaucoma services. Integrating enhanced optometric services into primary care incurred a similar cost. The workforce survey confirms that optometrists possess the skills and qualifications and are willing to deliver these enhanced optometric services. The Realist Review and Evaluation revealed that clear patient communication, effective coordination and strong interprofessional communication between optometrists and ophthalmologists along with a shared electronic record are crucial to the success of this change. Providing enhanced optometric services in primary care for nAMD and glaucoma brings substantial benefits for the UK National Health Service and patients, including reduced waiting times, waiting lists and released HES capacity. The success of this transition hinges on clear patient communication, administrative co-ordination and effective interprofessional communication.

Review of Ocular and Non-Ocular causes of Headache in Adult and Pediatric Patients; A multicenter study

Purpose: To determine ocular and non-ocular causes of headache in adult and pediatric patients in three tertiary care hospital of Multan, Pakistan Study Design: Cross-sectional study. Place and Duration of Study: This multi-centre study was conducted in Combined Military Hospital, Multan, Pakistan and The Children’s Hospital and The Institute of Child Health, Multan, Pakistan from February 2023 to September 2023. Methods: The non-probability convenience sampling technique was used. The data collection and diagnosis were done by a consultant ophthalmologist. The statistical analysis of this study was conducted using SPSS version 23. Results: The study comprised of a total of 600 patients. The mean age of the adult patients was 27.16±14.39 years ranging between 16to 80 years and the mean age of pediatric patients was 10.1±2.40 years. The patients were divided into four groups based on the etiology of headache that were ocular, non-ocular, combined ocular causes and ocular and non-ocular causes combined. The most common ocular cause was myopia in 43(14.3%) adults and 47 (15.8%) pediatric patients. However, the most common non-ocular cause was migraine in 72(24.0%) adult patients and frontal sinusitis in 43 (14.3%) pediatric patients. Conclusion: Refractive errors were the most common ocular etiology of headache in ophthalmology patients predominately myopia in the adult and pediatric population. Migraine was the most common non-ocular etiology in adult population whereas frontal sinusitis was most common in the pediatric age group.

The Impact of the COVID-19 Pandemic on Tele-ophthalmology-Based Retinal Screening.

This study reports our experiences with systematic retinal screening in Denmark through optometrists with access to tele-ophthalmological services before, during, and after the COVID-19 pandemic. We evaluated an optometrist-based retinal screening system with a referral option for tele-ophthalmological service by a consultant ophthalmologist within the time period of August1, 2018 to September30, 2023. The optometrist collected patient history, refraction, best-corrected visual acuity, intraocular pressure, basic slit-lamp examination, 4-in-1 visual field report, and retinal imaging using color fundus 45° photography. Tele-ophthalmological services were provided by consultant ophthalmologists. Within pre-defined periods of pre-COVID-19, COVID-19, and post-COVID-19, we evaluated the rate of referrals to the tele-ophthalmological service, diagnoses made, and referrals to the public healthcare system. A total of 1,142,028 unique individuals, which corresponded to 19.1% of the entire population of Denmark, underwent screening by the optometrists; 50,612 (4.4%) of these individuals were referred to the tele-ophthalmological examination by consultant ophthalmologists. A referral for further ophthalmic examination, either at hospital or at an ophthalmic practice, was made for 10,300 individuals (20.4% of those referred for tele-ophthalmology, corresponding to 0.9% of the population screened). The referral rate from the screening to the tele-ophthalmological service increased from before COVID-19 (3.4%) to during COVID-19 (4.3%) and further after COVID-19 (6.4%). This increase coincided with an increasing prevalence of conditions seen in the tele-ophthalmological service. During a period of 5years, 19.1% of the entire population of Denmark underwent retinal screening. This provided an adjunctive health service during a period of severe strain on the public healthcare system, while limiting the number of excessive referrals to the public healthcare system. Temporal trends illustrated an increased pattern of use of a large-scale tele-ophthalmological system.

Development and Validation of a Deep Learning Algorithm for Differentiation of Choroidal Nevi from Small Melanoma in Fundus Photographs

To develop and validate a deep learning algorithm capable of differentiating small choroidal melanomas from nevi. Retrospective multicenter cohort study. A total of 802 images from 688 patients diagnosed with choroidal nevi or melanoma. Wide field and standard field fundus photographs were collected from patients diagnosed with choroidal nevi or melanoma by ocular oncologists during clinical examinations. A lesion was classified as a nevus if it was followed for at least 5 years without being rediagnosed as melanoma. A neural network optimized for image classification was trained and validated on cohorts of 495 and 168 images and subsequently tested on independent sets of 86 and 53 images. Area under the curve (AUC) in receiver operating characteristic analysis for differentiating small choroidal melanomas from nevi. The algorithm achieved an AUC of 0.88 in both test cohorts, outperforming ophthalmologists using the Mushroom shape, Orange pigment, Large size, Enlargement, and Subretinal fluid (AUC 0.77) and To Find Small Ocular Melanoma Using Helpful Hints Daily (AUC 0.67) risk factors (DeLong's test, P<0.001). The algorithm performed equally well for wide field and standard field photos (AUC 0.89 for both when analyzed separately). Using an optimal operating point of 0.63 (on a scale from 0.00 to 1.00) determined from the training and validation datasets, the algorithm achieved 100% sensitivity and 74% specificity in the first test cohort (F-score 0.72), and 80% sensitivity and 81% specificity in the second (F-score 0.71), which consisted of images from external clinics nationwide. It outperformed 12 ophthalmologists in sensitivity (Mann-Whitney U, P=0.006) but not specificity (P=0.54). The algorithm showed higher sensitivity than both resident and consultant ophthalmologists (Dunn's test, P=0.04 and P=0.006, respectively) but not ocular oncologists (P>0.99, all P values Bonferroni corrected). This study develops and validates a deep learning algorithm for differentiating small choroidal melanomas from nevi, matching or surpassing the discriminatory performance of experienced human ophthalmologists. Further research will aim to validate its utility in clinical settings. Financial DisclosuresProprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Primary care optometry-based diabetic retinopathy review clinics - a new model of care and comparison with virtual diabetic retinopathy clinics.

Given the increasing prevalence of diabetes and diabetic retinopathy (DR) in the UK, this study evaluates a novel primary care optometry-based DR review service against traditional hospital-based virtual DR clinics. In the hospital-based virtual DR service, patients attended for data capture (visual acuity, fundus photography, macular OCT scanning) with asynchronous review at a later data by a hospital clinician. In the primary care optometry DR review clinic, patients attended an optometry practice for a face-to-face(F2F) review (with imaging) by an optometrist with additional training in DR. Data from both clinic types were analysed. Metrics included DR grading, management plans, grading concordance between primary care optometrists and consultant ophthalmologists, and the assessment of "ungradable" retinopathy referrals. One thousand seven hundred and sixty patients attended the virtual clinic between January 2021 and September 2023.954 patients attended the primary care review clinic between August 2022 and September 2023. Grading agreements between primary care optometrists and hospital consultants on those patients referred for consultant opinion were significant with Weighted Kappa scores of 0.61(95% CI 0.52-0.69) for DR grade and 0.69(95% CI 0.56-0.82) for diabetic macular oedema (DMO) status. Additionally, the primary care optometry clinic reported a considerably reduced non-attendance rate of 5%, in contrast to 21% in virtual clinics. The primary care optometry-based DR service emerges as an efficient, safe alternative to hospital services. It offers notable advantages over virtual clinics and addresses a care gap for those unsuitable for virtual consultations. The results highlight the potential of primary care-based models in managing DR.

A 12-year follow up survey of childhood blindness at schools for the blind in Cambodia

BackgroundCambodia is a low-income country in South East Asia with a population of 15.5 million people of whom 4.9 million (38%) are under the age of 16. The causes of childhood blindness in Cambodia have not been investigated since the first survey of schools for the blind done in 2009 by our group. Given the large demographic and economic shifts in Cambodia since 2009 it is important to determine if these causes have changed in order to ensure intervention programmes are appropriately targeted. The purpose of the present study is to investigate the prevalence of causes of childhood blindness at schools for the blind in Cambodia.MethodsStudents between the ages of 5 and 16 years who were attending schools for the blind in Cambodia were examined by a consultant paediatric ophthalmologist and had clinical photographs taken. Distance visual acuity was measured using a logMAR tumbling E chart and the WHO definitions of blindness and severe visual impairment were used. The examining ophthalmologist recorded the anatomical site and aetiology of vision loss using the WHO Prevention of Blindness eye examination record for children. Collected data were compared to a previous survey from 2009.ResultsData from 73 students were included for analysis. The most common anatomical location of abnormality causing vision loss was the cornea (n = 20, 33.9%) followed by the lens and retina (n = 11, 18.64% each). Hereditary factors (n = 29, 49.15%) and childhood diseases (n = 27, 45.76%) were the most common aetiological causes of childhood blindness. The majority (71.19%) of childhood blindness was avoidable. The present study did not demonstrate 0a significant difference in the causes of childhood blindness compared to 2009.ConclusionsCorneal pathologies continue to represent the most common cause of vision loss amongst the surveyed population and the majority of causes of childhood blindness continue to be avoidable. These findings will facilitate the development of evidence-based targeted interventional programmes in Cambodia.

Oral fluorescein angiography in the diagnosis of paediatric optic nerve abnormalities.

FFA is a well-established investigation for the diagnosis of optic nerve abnormalities, requiring an intravenous cannula and extended imaging acquisition time. Cannulation can present a challenge in paediatric patients and whilst oral FFA has been used for decades, it has been limited by imaging technology and unconfirmed image acquisition timings. For years, we have used a modern ultra-widefield retinal camera, and established imaging time-points to demonstrate dynamic optic nerve head changes upon ingestion of fluorescein and collected a database of oFFA images for various presentations. Using an established protocol, optic nerve colour images were obtained, followed by oral administration of fluorescein dye. The optic nerves are then imaged at established intervals. An interpretation of oFFA tutorial was delivered to consultant ophthalmologists and trainees. Subsequently, these groups were assessed using a series of fifteen cases with the sensitivity and specificity of the test determined. Our study presents a series of images and descriptions for common optic nerve abnormalities in paediatric populations. In the interpretation part of the study, overall sensitivity of 76.8% in the consultant group vs 63.3% in the combined consultant + trainees and specificity of 87.5% vs 68.4% in the combined group. This is the first study that describes characteristic features of several common, and serious, optic nerve abnormalities specifically for oFFA interpretation in a paediatric population. It also highlights the rapid accumulation of oFFA interpretation skills in non-specialist consultant and trainee ophthalmologists such as to obtain a high diagnostic accuracy with high sensitivity and specificity.

Dry Eyes Illness in Psychiatric Patients Placed on Antipsychotic Medications

Introduction: Psychosis is used to describe conditions that affect the mind where there has been loss of contact with reality. Most psychotic disorders are treated with a combination of medications and psychotherapy. A significant ocular side effect of anti-psychotic drugs is dry eyes which often do not get adequate attention thus leading to great discomfort to the patient. Methodology: The study was a hospital-based, case-control prospective study where patients diagnosed with a psychotic disorders within the age groups of 18 to 70 years and who have been on anti-psychotic treatment for at least one year were examined by a consultant ophthalmologist. Healthy adults were enrolled from the Ophthalmology outpatient clinic as the control for the study. Result: The case group comprised 53(44.9%) males and 65(55.1%) females. The age group with the highest representation amongst the cases- 29.7% was the 29-38-year-olds. On the medication history, 65(55.1%) started taking antipsychotic drugs within 1-5 years. 65.3% of the respondents were on antipsychotic monotherapy-commonly Olanzapine tablets. Schirmer’s test was normal in most of the participants in both cases 50.8% and control 53.4% but those that have been on medication for 5 years or less demonstrated the highest occurrence of severe dry eyes with a prevalence rate of 23.1% while those on medication for over 10 years showed a higher prevalence of mild dry eyes accounting for 20.8% of the cases. Tear film Break-up Time (TBUT) showed Dry eyes in 50.8% of cases. A significant proportion (56.9%) of those who had been on medication for 1-5 years were found to be exhibiting dry eyes. Conclusion: An association was observed between Dry eye disease and antipsychotic medication as early as within 1-5 years of using the medication. Ophthalmic assessment should be incorporated early in the course of treatment.

Comparison Between Efficacy and Safety of Oral Azithromycin (250mg) vs Oral Doxycycline (100mg) in Treatment of Meibomian Gland Dysfunction (MGD)

Objective: To compare the efficacy and safety of oral Azithromycin with oral Doxycycline in patients with Meibomian Gland Dysfunction.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of the Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Apr 2021 to Apr 2022.&#x0D; Methodology: The sample population comprised 172 subjects, including 86 cases in the oral Doxycycline-Group and 86 oralAzithromycin-Group. Meibomian Gland Dysfunction was diagnosed by a consultant ophthalmologist by slit-lampexamination. Schirmer-I test and Tear Break Up Time were performed. Signs and symptoms of Meibomian Gland Dysfunction were assessed before treatment and at six months follow-up.&#x0D; Results: The study recruited equal numbers of cases and controls. Symptoms scores for burning sensation (2.04±0.5 vs 1.9±0.7) and foreign body sensation (1.8±0.6 vs 1.5±0.8) were significantly higher in patients taking Doxycycline as compared to the Azithromycin-Group (p&lt;0.05). On comparing the signs score between the two Groups, it was seen that total scores (pretreatment and post-treatment) were more significant in the Doxycycline-Group (p&lt;0.05). Treatment with Doxycycline yielded more significant complications, such as diarrhoea (39.5%), nausea (46.5%), and cramps (48.8%). Headache was more associated with Azithromycin treatment (3.4%), whereas Rash (1.1%) and blurring of vision (1.1%) were seen in the Doxycycline-Group.&#x0D; Conclusion: Meibomian Gland Dysfunction leads to tear film instability and direct damage to the ocular surface epithelium. This study supports the clinical efficacy and safety of oral Azithromycin and Doxycycline therapy for managing refractory or severe Meibomian gland disease.

CPD: Retinoblastoma: An update

In the first of two articles looking at retinoblastoma, consultant paediatric ophthalmologist Mr Joe Abbott offers an overview of the disease (C106043, suitable for logging as one distance learning CPD point for optometrists and dispensing opticians)

Commentary: Scleral penetration or perforation during strabismus surgery.

Commentary: Scleral penetration or perforation during strabismus surgery.

Risk factors of diabetic retinopathy - a cross sectional study from Holy Family Hospital, Rawalpindi.

Objective: To assess the major risk factors of diabetic retinopathy in patients presenting to the eye OPD of the Holy Family Hospital, Rawalpindi. Study Design: Descriptive Cross-sectional study. Setting: Department of Ophthalmology, Holy Family Hospital, Rawalpindi. Period: March 2018 to September 2018. Material &amp; Methods: 330 patients presenting at the diabetic clinic of Holy Family Hospital aged between 30-70 years with both type I and type II diabetes for ≥5 years (diagnosed by checking fasting blood sugar or HbA1C). History including age, gender, weight, height, duration of diabetes mellitus and control of diabetes mellitus was taken on a pre-designed proforma. Slit lamp examination was performed by the consultant ophthalmologist to check for Diabetic Retinopathy (NPDR and PDR). Results: Mean age of the patients was 50.4±9.8. Patients were distributed according to the age groups showing that 56(56%) of the patients were diabetics, 61(49.9%) with NPDR and 48(48%) with PDR in the 30-50 year group. While 51-70 year group included 44(44%) diabetics, 69(53.1%) with NPDR and 52(52%) with PDR. There was no significant association between history of hypertension and diabetic retinopathy (p=0.804) or BMI and diabetic retinopathy (p=0.451). There was significant association between diabetic retinopathy and duration of diabetes (p=0.035) as well as diabetic retinopathy and Hb1Ac levels (p=0.001). Gender variations were statistically significant (p=0.001), with females being more affected than males. Conclusion: Diabetic retinopathy is strongly associated with female gender, longer duration of diabetes and poor glycemic control.

Diagnostic accuracy of direct ophthalmoscopy in the rapid assessment of avoidable blindness protocol: A cross-sectional study

Background: Rapid Assessment of Avoidable Blindness (RAAB) relies mainly on direct ophthalmoscopy (DO) for the diagnosis of posterior segment eye diseases (PSEDs). There is, however, a growing concern that DO may not be sufficiently sensitive to detect PSED owing to inherent diagnostic limitations. Aim of the Study: The aim of the study was to determine the sensitivity and specificity of DO for the detection of PSEDs in RAAB, using indirect ophthalmoscopy (IO) as a reference standard. Materials and Methods: Participants were patients 50 years and older, presenting to the eye clinic of a tertiary hospital in Jos, between April and September 2016 who gave consent. Their visual acuity was assessed as is done in RAAB6. Those found to be unilaterally or bilaterally visually impaired underwent anterior and posterior segment eye examinations to identify the cause. Dilated fundoscopy was first performed by a senior ophthalmology resident with DO (index test), followed by IO (reference standard test) by a consultant ophthalmologist. Results: A total of 250 patients were recruited into the study, of which 188 took the index and reference standard tests. PSEDs were detected in 65 (34.6%) persons and glaucoma accounted for 87.7% of these. The sensitivity of DO for the detection of glaucoma was 95.3%, while the specificity was 91.0%. Sensitivity and specificity for the detection of diabetic retinopathy and central retinal vein occlusion were both 100%. Specificity for the detection of other PSEDs was good even though sensitivity was below acceptable limits. Conclusion: The performance of DO against IO in this study, suggests that it is a satisfactory modality for the detection of the most common PSEDs in RAAB.

Effect of Intra-Stromal Bevacizumab on Corneal Vascularization

Purpose: To study the effect of Intra-stromal Bevacizumab on corneal vascularization. Study Design: Quasi experimental study. Place and Duration of Study: Outpatient department of the Combined Military Hospital, Multan from April 2022 to August 2022. Methods: Thirty patients were recruited through non-probability, convenience sampling technique. Ethical approval was taken from Institutional Review Board. Complete ocular examination was performed by a consultant ophthalmologist and patients with corneal neovascularization were included in the study. Area of corneal vascularization was measured on slit lamp. After taking all the aseptic measures and administering anesthetic eye drops, patients were administered 0.2 ml of (2.5 mg/0.1 mL) Bevacizumab (Avastin, Roche) using an ophthalmic microscope. The patient was then called for a follow up after 4 weeks and then the grade of corneal vascularization was checked by a consultant ophthalmologist on slit lamp examination. Data analysis was doneusing SPSS version 25. Results: Mean age of the patients was 43.4 ± 13.7 years (range 25 to 72 years). Male to female ratio was 2:3. There was significant decrease in the area of corneal neovascularization from 2.78mm ± 0.30 to 2.50mm ± 0.27 (p = 0.0003). The mean change in the area of corneal neovascularization was 10.07%. Two patients had sub-conjunctival hemorrhage which settled over due course of time. Conclusion: Intra-stromal Bevacizumab resulted in significant reduction in vascularized area of cornea with minimal side effects indicating that intra-stromal Bevacizumab is an effective and safe modality in the treatment of corneal neovascularization.

A Prospective Audit Comparing Optos Widefield Imaging to Fundus Examination for Von Hippel-Lindau Retinal Screening.

Background Von Hippel-Lindau (VHL) disease is an autosomal dominant multisystem disorder caused by germline mutations at chromosome 3p25-26 in the VHLtumour suppressor gene. Retinal manifestations include capillary haemangiomas that develop in up to 80% of gene carriers. Lifelong retinal surveillance involves yearly assessment usually by fundoscopy and often as part of a VHL multidisciplinary clinic. Optos ultra-widefield retinal imaging is now becoming more widely used in virtual retinal screening clinics. We aimed to assess discrepancies in the pickup rate of angioma and angiomatous-associated disease between slit-lamp fundoscopy and Optos ultra-widefield imaging. Methodology A total of 49 patients had both Optos ultra-widefield retinal imaging and slit-lamp fundoscopy over16 months in VHL retinal surveillance clinics at the John Radcliffe Hospital, Oxford, UK. Optos images were analysed for image quality and presence of angioma(s) by a Consultant Ophthalmologist who was masked to the fundoscopy findings. The pickup rate was compared between slit-lamp fundoscopy and Optos imaging. Results In total, data on 94 eyes were collected. Of the total Optos retinal images,12.8% were positive for angiomas compared to 11.7% from the slit-lamp examination. There was a discrepancy of 1.1% (one value) where the Optos image analysis suggested a possible angioma, which was not identified on slit-lamp examination. Optos imaging identified all angiomas in this cohort. Conclusions Optos imaging was non-inferior to slit-lamp examination in this sample of 94 eyes. In the current COVID-19 climate, reducing clinician-patient interaction is important. This research supports providing retinal imaging as an acceptable alternative to the yearly slit-lamp fundus examination.

Only eye study 3 (OnES 3): a qualitative study into how surgeons approach surgery in patients with only one seeing eye

ObjectivePerforming surgery on an ‘only eye’ patient is considered high stakes. The purpose of this study is to explore the process of only eye surgery from the perspective of ophthalmic...

Frequency of Dry Eyes with and without Posterior Blepharitis in Diabetes Patients

Objective: To assess the frequency of dry eyes with and without posterior blepharitis in diabetic patients managed in our hospital.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan from Feb to Jun 2021.&#x0D; Methodology: A total of 160 patients suffering from type-2 Diabetes Mellitus with blood sugar fasting of more than 126mg/dl were included in the study. Dry eyes were assessed with Tear break up time tests and Schirmer. A consultant ophthalmologist conducted a detailed ophthalmological examination to diagnose posterior blepharitis among the study participants. &#x0D; Results: There were 160 patients enrolled in this study. The mean age was 52.68±11.8 years. The study included 74(46.3%) male and 86(53.8%) female patients. It was found that tear-breaking time was significantly lower for diabetic patients with blepharitis as compared to diabetic patients without blepharitis (p&lt;0.001). Similarly, the duration of diabetes was also found to be associated with tear breakup time. Patients who had diabetes for more than ten years were more likely to have a tear breakup time of fewer than 10 seconds compared to patients who had diabetes for not more than ten years (p&lt;0.001).&#x0D; Conclusion: Dry eye syndrome was common among patients suffering from type-2 diabetes mellitus. Patients with longstanding diabetes or those with posterior blepharitis were more at risk of dry eyes than those without posterior blepharitis or a shorter duration of diabetes mellitus.

Genetic heterogeneity of primary open-angle glaucoma in Pakistan

BackgroundGlaucoma is a neurodegenerative ophthalmic disorder and is considered among the leading causes of irreversible blindness. Primary open-angle glaucoma (POAG) is the most common type of glaucoma that affects after 30 years of life, progressing slowly, and manifests as decreased visual acuity leading to blindness if not treated. POAG is genetically heterogeneous, inherited most commonly in autosomal dominant mode. Several genes have been reported for POAG with myocilin (Myoc) being most common. The present study has been conducted to screen 25 POAG families with 2 or more affected members for their association with Myoc and CYP1B1 (the most common gene in primary congenital glaucoma). MethodsAfter approval from Institutional Ethical Review Committee (ERC), 25 POAG families were enrolled from the southern province (Sindh) of Pakistan. Written informed consent was obtained from all participating individuals and diagnosis was confirmed by consultant ophthalmologists using various instruments and means. Venous blood was obtained from affected individuals and their normal family members for DNA extraction and subsequent analysis. ResultsAll samples were initially screened for the Myoc gene followed by CYP1B1. Screening for Myoc revealed one previously reported variant c.144G>T in POAG-06 whereas screening for CYP1B1 in all 25 families showed a novel variant c.649G>A in POAG-02. The pathogenicity of the novel variant was confirmed using various bioinformatics tools. ConclusionThis is the first report of any POAG family found associated with a novel variant in CYP1B1 from the southern province of Pakistan whereas one family found associated with a reported variant in Myoc. The remaining 23 POAG families did not found to be associated with either Myoc or CYP1B1 indicating genetic heterogeneity of the population in this part of the world.

A smartphone lens attachment improves the quality of referrals to eye casualty.

Background/objectivesIn recent years, eye casualty clinics have seen significant increases in patient numbers with reduced capacity. COVID-19 has exacerbated this issue and demonstrated the potential of telemedicine as a solution. Our study evaluated the potential benefit of a smartphone-based lens attachment to improve the referral pathway for anterior segment related complaints in eye casualty.Subjects/methodsFifty-four consecutive patients with anterior segment complaints were recruited. A questionnaire was completed with each patient to simulate the history from the point of referral. White light and cobalt blue photos were captured using a smartphone lens. The clinician reviewing the patient was asked to document the actual diagnosis and the appropriate time-frame within which they felt the patient could safely have been seen within; both with and without the option of management advice at the time of triage. The subsequent images and questionnaires were reviewed by a single consultant Ophthalmologist who was independent to the data collection process. The assessor was asked to make a diagnosis and management plan based upon the questionnaire (‘History’), and the questionnaire with the photo (‘History with Image’), as well as rate their clinical confidence on a 1–5 scale.ResultsDiagnostic accuracy was significantly higher in “History with Image” (98.2%), when compared to “History” only (48.2%). “History with Image” prevented significantly more appointments when compared to “History” alone, at similar levels to retrospective clinic review. Preventable appointments were increased if clinical advice was possible. Timeframe of appointments between ‘History with Image’ and ‘Clinic’ appointments was similar. Clinical’Confidence was significantly higher at 4.5 with ‘History with Image’ when compared to 2.37 with ‘History Only’.ConclusionA low-cost smartphone lens attachment, alongside a standardised clinical questionnaire, can improve the referral pathway to the hospital eye service by reducing unnecessary appointments, while improving clinical confidence and diagnostic accuracy during triage. Further work to evaluate referral pathways, including the development of systems that allow for secure image transmission are needed to understand the feasibility for the widespread adoption of this technology.