Eye Care Physicians Research Articles

Clinical performance after implantation of an EDOF intraocular lens in the dominant eye and a presbyopia-correcting intraocular lens in the nondominant eye.

To evaluate subjective and objective outcomes after combined implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL) and a combined technology multifocal lens (CT-IOL). 2 clinical practices (Carolina Eyecare Physicians, Center For Sight) in the United States. Prospective, unmasked, multicenter, nonrandomized bilateral eye study. Patients interested in reducing their dependence on spectacles were implanted with an EDOF IOL in the dominant eye and a CT-IOL in the nondominant eye. Refractive and visual acuity (VA) data at various distances (4 m, 66 cm, 40 cm, and 33 cm) were collected 3 months postsurgery, along with the distance-corrected binocular defocus curve and responses to questionnaires related to spectacle independence, visual disturbances, and overall visual function. Data from 37 participants were analyzed. The distance-corrected binocular defocus curve showed a mean VA better than 0.1 logMAR (20/25) at all vergences from +1.00 to -2.50 diopters (D). 36 participants (97%) had an uncorrected binocular VA of 0.3 logMAR or better, at all test distances. 70% of participants (26/37) reported never wearing spectacles at any distance, and 84% (31/37) were "completely" or "mostly" satisfied with their overall vision after surgery. Halos were the disturbance reported most frequently and reported as most bothersome, with difficulty driving at night the most common visual function issue. Difficulty reading was the next most reported issue. Overall eyesight was rated as "excellent" or "good" by 92% (34/37) of participants. This combined EDOF/CT-IOL approach was well-tolerated by participants and provided some potential benefits relative to bilateral implantation of either lens.

Knowledge and Perceptions of Artificial Intelligence Use in Screening for Diabetic Retinopathy in Botswana: Survey for Eye Care Clinicians

Diabetic retinopathy (DR), is one of the most prevalent visual impairments in the country and is on the rise. The study seeks to investigate eye care physicians' knowledge and perceptions on the use of artificial intelligence (AI) in screening for DR in the country. Materials and Methods A convenience sample of voluntary willing participants completed an online survey. All information was entered in Microsoft excel and analyzed utilizing SPSS v22.0. Results 83% of clinicians indicated no awareness of AI fundus examinations. 66.7% had no understanding what the word AI meant. 100% of clinicians said they have never used AI software for DR screening. The study's knowledge of the use of AI was tested using "AI fundus exams", and as a result, it was poor. There was a 66.7% positive attitude towards employing AI-integrated workflow vs a 33.3% negative attitude. 50% strongly agreed that artificial intelligence would help the field of DR screening. Conclusion Overall, clinicians have limited knowledge on the use of AI technology. Regardless, they are optimistic about its possibilities, thus AI adoption and training for eye care practitioners on how to use it should be considered in the country's public health system.

Laser Pointer Retinopathy: A Case Report and Review

Purpose: Laser pointer retinopathy is a condition increasing in prevalence due to poor education of proper laser use at the childhood/teenage level and poor awareness of risks and complications of laser pointers among the adult population. Eye care physicians can serve as an important bridge among these populations to help increase awareness and promote and educate patients on the potentially damaging retinal effects associated with laser pointer viewing/exposure. Pathophysiology, signs and symptoms, multimodal imaging interpretation, and treatment management options of laser pointer retinopathy are reviewed through a case study. Background: A 19-year-old male presented to the eye clinic without any ocular or visual complaints for a routine eye examination. Fundus examination revealed yellow subfoveal scarring in the left eye and corresponding damage to the foveal ellipsoid zone on optical coherence tomography imaging. Amsler grid findings further confirmed metamorphopsia that was present only in the left eye. Further questioning determined the foveal damage to be laser pointer retinopathy secondary to extended laser pointer viewing. Conclusions: Laser pointer retinopathy is an increasingly prevalent retinal finding in younger populations. In most cases vision loss slowly improves with time, but the retinal damage has often been reported to be irreversible. Considering this information, it is imperative for optometrists to educate school staff, parents and children of the permanent ocular damage that can occur with laser pointer viewing and promote safe practices. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. Click here to Enroll (https://www.crojournal.com/laser-pointer-retinopathy-a-case-report-and-review)

Impact of the affordable care act on utilization of benefits of eye care and primary care examinations

PurposeTo determine the impact of the Affordable Care Act (ACA) on utilization of benefits of both eye care and primary care examinations in individuals who did not have health insurance prior to the ACA.MethodsPatients examined in an urban eye clinic from 2017 to 2018 were invited to participate. Patients were classified into two groups: Insured Group, who had health insurance before and after the ACA; The ACA Group, who had insurance only after the ACA. Patients were surveyed on how often they were examined by their eye care and primary care physicians before and after the ACA. The care utilization frequency was categorized into 3 levels: Frequent Care Use, Rare Care Use, and Never. To test the utilization of benefits frequency difference between two groups, the z-ratio was calculated.ResultsA total of 4,355 patients were enrolled with 87.1% in the Insured Group and 12.9% in the ACA Group. After the ACA implementation, the percentage of “Frequent Care Use” of the eye care and primary care in the ACA Group patients significantly increased from 31.2% and 53.7% to 57.9% and 74.9%, respectively (P<0.001), but were significantly lower than those in the Insured Group (76.6% and 93.9%, P < 0.001).ConclusionThe ACA significantly improved utilization of benefits of eye care and primary care for individuals in the ACA Group. Although improved, those patients who received health insurance through the ACA still had lower utilization of benefits than those in the Insured Group.

Ocular Findings in COVID-19 Patients: A Review of Direct Manifestations and Indirect Effects on the Eye.

The novel pandemic coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has challenged the medical community. While diagnostic and therapeutic efforts have been focused on respiratory complications of the disease, several ocular implications have also emerged. SARS-CoV-2 RNA has been found in tears of the infected patients, and reports suggest that the ocular surface could serve as a portal of entry and a reservoir for viral transmission. Clinically, COVID-19 has been associated with mild conjunctivitis, which can be the first and only symptom of the disease. Subtle retinal changes like hyperreflective lesions in the inner layers on optical coherence tomography (OCT), cotton-wool spots, and microhemorrhages have also been reported. In addition, COVID-19 has been associated with an increased incidence of systemic diseases like diabetes mellitus and Kawasaki disease, which are particularly relevant for ophthalmologists due to their potentially severe ocular manifestations. Several treatment strategies are currently under investigation for COVID-19, but none of them have been proved to be safe and effective to date. Intensive care unit patients, due to risk factors like invasive mechanical ventilation, prone position, and multiresistant bacterial exposure, may develop ocular complications like ocular surface disorders, secondary infections, and less frequently acute ischemic optic neuropathy and intraocular pressure elevation. Among the array of drugs that have shown positive results, the use of hydroxychloroquine and chloroquine has raised a concern due to their well-known retinal toxic effects. However, the risk of retinal toxicity with short-term high-dose use of antimalarials is still unknown. Ocular side effects have also been reported with other investigational drugs like lopinavir-ritonavir, interferons, and interleukin-1 and interleukin-6 inhibitors. The aim of this review was to summarize ophthalmological implications of SARS-CoV-2 infection to serve as a reference for eye care and other physicians for prompt diagnosis and management.

Ocular Adverse Effects of Amiodarone: A Systematic Review of Case Reports.

Amiodarone is an excellent antiarrhythmic medication; however, it has numerous systemic and ocular adverse effects. We aimed to improve our understanding of amiodarone and its ocular adverse effects by performing a systematic review and meta-analysis of published case reports. This systematic review was reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. We used the MEDLINE database, primarily through PubMed, and used keywords (amiodarone, eye, eye diseases, visual/ocular adverse effects/manifestations) to identify case reports of ocular adverse effects after amiodarone use. The initial search resulted in 92 total case reports. However, after excluding nonrelevant case reports, 25 cases were selected for the final analysis. Among the patients in the 25 case reports, 18 were male (72%), and the median age was 66 ± 9.9 years. In 15 cases (60%), the patients reported halos around light and/or decrease in vision after amiodarone use. The most common ophthalmic examination findings were cornea verticillata/vortex keratopathy in 19 cases (76%), followed by different patterns of papilledema and retinal hemorrhages in 5 cases (20%). Discontinuation of amiodarone was the most common intervention, followed by application of topical heparin. Outcomes among case reports were variable. Cornea verticillata/vortex keratopathy was the most common ocular adverse effect in cases where amiodarone was administered. Early recognition of amiodarone-induced ocular adverse effects is imperative to prevent worsening keratopathy or uncommon adverse effects. Collaboration between physicians prescribing amiodarone-to recognize the ocular symptoms-and referral to eye care physicians are important.

Evaluating the relative value of intraoperative aberrometry versus current formulas for toric IOL sphere, cylinder, and orientation planning

To retrospectively review toric intraocular lens (IOL) outcomes and compare actual results to those expected from preoperative calculations and intraoperative aberrometry (IA) in normal eyes. Carolina Eyecare Physicians, Mt. Pleasant, South Carolina, USA. Retrospective data review of earlier clinical trial data. Toric IOL planning data and results were obtained from two previous clinical studies of normal eyes receiving toric IOL implants. Back-calculation techniques were used to estimate expected residual refractive sphere and cylinder for preoperative and IA calculations. Toric IOL planning data and clinical outcomes for 132 eyes receiving two different toric IOLs were analyzed. The mean spherical equivalent refractions expected with preoperative planning and IA were not statistically significantly different (P=.44), but a higher percentage of eyes within ±0.50 D of the intended spherical refraction was expected with preoperative calculations (P=.05). The mean expected residual refractive astigmatism based on preoperative calculations was significantly lower than for IA (P<.001), with more eyes expected to have 0.50 D or less of residual refractive astigmatism. The use of current-generation formulas for sphere power and toric IOL planning in normal eyes seems sufficient to produce clinical outcomes with toric IOLs that are as good or better than those achieved using IA.

PixelBNN: Augmenting the PixelCNN with Batch Normalization and the Presentation of a Fast Architecture for Retinal Vessel Segmentation.

Analysis of retinal fundus images is essential for eye-care physicians in the diagnosis, care and treatment of patients. Accurate fundus and/or retinal vessel maps give rise to longitudinal studies able to utilize multimedia image registration and disease/condition status measurements, as well as applications in surgery preparation and biometrics. The segmentation of retinal morphology has numerous applications in assessing ophthalmologic and cardiovascular disease pathologies. Computer-aided segmentation of the vasculature has proven to be a challenge, mainly due to inconsistencies such as noise and variations in hue and brightness that can greatly reduce the quality of fundus images. The goal of this work is to collate different key performance indicators (KPIs) and state-of-the-art methods applied to this task, frame computational efficiency–performance trade-offs under varying degrees of information loss using common datasets, and introduce PixelBNN, a highly efficient deep method for automating the segmentation of fundus morphologies. The model was trained, tested and cross tested on the DRIVE, STARE and CHASE_DB1 retinal vessel segmentation datasets. Performance was evaluated using G-mean, Mathews Correlation Coefficient and F1-score, with the main success measure being computation speed. The network was 8.5× faster than the current state-of-the-art at test time and performed comparatively well, considering a 5× to 19× reduction in information from resizing images during preprocessing.

Omega-3 Supplement; A Comparison of Recommendations

Purpose: Research has shown Omega-3 supplementation can benefit dry eye patients. Our objective is to aid optometrists in the treatment of dry eye syndrome by summarizing the recommendations for oral Omega-3 supplements. Methods: We sent an online survey consisting of ten questions to optometrists affiliated with the Oklahoma Association of Optometric Physicians (OAOP) and the Facebook groups ODs on Facebook and Corporate Optometry to see if they are recommending Omega-3 supplements, which specific products, and at what dosage. Results: Ninety-five optometrists responded. 43.16% stated that their dry eye patients number between 26-50% of their practice. 60% responded they recommend Omega-3 supplements, and 37.89% said they tell their patients to increase their dietary fish intake and take Omega-3 supplements. 50% of eye care physicians responded that they sell dry eye supplements. When asked about how familiar optometrists are with the different forms of Omega-3 fatty acids, 30.85% stated they are very familiar, while 54.26% stated they are somewhat familiar and 14.89% stated they are not familiar at all with the differ-ent types. Conclusion: We found that the majority of optometrists who responded to our survey are recommending their patients consume between 1500-2000 milligrams of Omega-3’s per day for dry eye. Many health professionals uphold that at least 1,000 mg/day of EPA and DHA should be consumed to aid in improving systemic health. In the absence of stan-dards specifically for dry eye it is reasonable to base Omega-3 supplement recommenda-tions on those for systemic health.

Prevalence of Undiagnosed Age-Related Macular Degeneration in Primary Eye Care

Age-related macular degeneration (AMD) is the leading cause of irreversible vision impairment in older adults in the United States, yet little is known about whether AMD is appropriately diagnosed in primary eye care. To examine the prevalence of eyes with AMD in patients seen in primary eye care clinics who purportedly have normal macular health per their medical record and the association of AMD with patient and physician characteristics. In this cross-sectional study of primary eye care practices in Birmingham, Alabama, 644 persons 60 years or older with normal macular health per medical record based on their most recent dilated comprehensive eye examination by a primary eye care ophthalmologist or optometrist were enrolled from May 1, 2009, through December 31, 2011. Data analysis was performed from May 1, 2016, through December 20, 2016. Presence of AMD as defined by the Clinical Age-Related Maculopathy Staging system based on color fundus photography and a masked grader. Types of AMD-associated lesions were noted. Patient health and physician characteristics were collected. The sample consisted of 1288 eyes from 644 participants (231 [35.9%] male and 413 [64.1%] female; mean [SD] age, 69.4 [6.1] years; 611 white [94.9%]) seen by 31 primary eye care ophthalmologists or optometrists. A total of 968 eyes (75.2%) had no AMD, in agreement with their medical record; 320 (24.8%) had AMD despite no diagnosis of AMD in the medical record. Among eyes with undiagnosed AMD, 32 (10.0%) had hyperpigmentation, 43 (13.4%) had hypopigmentation, 249 (77.8%) had small drusen, 250 (78.1%) had intermediate drusen, and 96 (30.0%) had large drusen. Undiagnosed AMD was associated with older patient age (odds ratio [OR], 1.06; 95% CI, 1.04-1.09; P < .001), male sex (age-adjusted OR, 1.39; 95% CI, 1.02-1.91; P = .04), and less than a high school education (age-adjusted OR, 2.40; 95% CI, 1.03-5.62; P = .04). Prevalence of undiagnosed AMD was not different for ophthalmologists and optometrists (age adjusted OR, 0.99; 95% CI, 0.71-1.36; P = .94). Approximately 25.0% of eyes deemed to be normal based on dilated eye examination by primary eye care physicians had macular characteristics that indicated AMD revealed by fundus photography and trained raters. A total of 30.0% of eyes with undiagnosed AMD had AMD with large drusen that would have been treatable with nutritional supplements had it been diagnosed. Improved AMD detection strategies may be needed in primary eye care as more effective treatment strategies for early AMD become available in the coming years.

Neck and shoulder muscle activity among ophthalmologists during routine clinical examinations

Muscular demands during common clinical ophthalmologic activities may contribute to the high prevalence of musculoskeletal health outcomes observed among ophthalmologists and other eye care physicians. Characterizations of the muscle activation patterns in the live ophthalmologic environment are lacking. This study was conducted to (i) characterize the frequencies and durations of common activities performed by ophthalmologists during routine clinical examinations, (ii) characterize neck and shoulder muscle activation patterns during the whole clinical work day, and (iii) explore differences in neck and shoulder muscle activation patterns between common clinical activities. Fifteen ophthalmologists performed routine patient examinations in an outpatient ophthalmology clinic while continuous surface electromyography measurements of the upper trapezius and anterior deltoid muscles were obtained. Results indicated that while computer use was the most frequently performed clinical activity, use of the indirect ophthalmoscope, followed by use of the slit lamp biomicroscope, required greater muscular demands than computer use or other clinical activities. Results provide evidence that the clinical activities of indirect ophthalmoscope and slit lamp biomicroscope use are appropriate for ergonomic intervention.

Vision Stations: Addressing Corrective Vision Needs With Low-cost Technologies.

Eyeglasses, required for functional vision by nearly half the world's population, are still needed by more than a billion people. There are a number of constraints on the provision of eyeglasses: product cost, durability, and appearance; traditional approaches to evaluating refraction; and sustainably scaling potential distribution methods. We offer our experience with an immigrant population in a US urban setting using a “Vision Station.” The station allowed for immediate provision of adjustable glasses using self-refraction, ordering of custom lenses from a low-cost website, and referral to primary and eye care physicians for those with medical eye concerns. As with models in development by other groups, Vision Stations connect people with the life-changing provision of functional vision.

Eye care providers' attitudes towards tele-ophthalmology.

The rapid rise of e-health and remote care systems will likely change the practice patterns of ophthalmologists. Although telemedicine practices are thriving in many specialties of medicine, telemedicine for ophthalmology has been limited primarily to asynchronous care for diabetic retinopathy. The goal of this research was to evaluate perspectives on and familiarity with telemedicine among eye care providers at a large tertiary-care medical center via an anonymous, descriptive survey. In total, 58 eye care physicians completed surveys (response rates of 86% for physicians-in-training and 49% for faculty physicians, respectively). Although a majority of both faculty and physicians-in-training were willing to participate in telemedicine services, trainees were more likely to be willing to interpret photographs than faculty (p=0.04). Most respondents (71%) indicated that they did not use telemedicine. Over half had received photographs (via phone or e-mail) for interpretation from referring physicians (54%) or patients (56%) within the past 3 months. A majority of providers (82%) would be willing to participate in telemedicine for consultations and for interpreting photographs, but a majority (59%) had low confidence in remote care for providing an opinion on patient care. Most eye care providers viewed telemedicine as part of the future of eye care but were concerned about the use of telemedicine. Although most providers did not practice telemedicine, over half of them were comfortable managing eye care consultations (including patients' photographs) via the Internet.

A Comparison of Examination Equipment Used During Common Clinical Ophthalmologic Tasks

OCCUPATIONAL APPLICATIONS Ophthalmologists and other eye-care physicians frequently use clinical examination equipment that restricts access to patients and requires the adoption of sustained, non-neutral working postures of the neck and shoulders. The use of ergonomic principles in the design of examination equipment could help reduce these physical demands, which may be partly responsible for the high prevalence of neck and shoulder pain among ophthalmologists. This study compared the effects of a set of this alternative “ergonomic” equipment to a set of conventional equipment on measures of neck and shoulder muscle activity and upper arm posture during simulations of common clinical ophthalmologic tasks. Results suggested that some aspects of the alternative equipment may help reduce exposures to sustained, non-neutral working postures of the neck and shoulder among ophthalmologists. Ophthalmologists and other eye-care physicians may consider implementing similar alternative equipment interventions into their practices.TECHNICAL ABSTRACT Background: Ophthalmologists report a high prevalence of work-related musculoskeletal symptoms, particularly of the neck and shoulders. Improving the design of equipment used in the clinical environment may reduce exposures to physical risk factors (e.g., sustained muscular exertions and non-neutral postures) associated with neck and shoulder pain among ophthalmologists. Purpose: This study compares estimates of neck and shoulder muscle activity and upper arm posture during use of conventional and alternative examination equipment common in clinical ophthalmologic practice. Methods: Fifteen ophthalmologists performed one mock clinical examination using conventional equipment and one mock clinical examination using alternative equipment with the potential to reduce exposure to sustained muscular exertions and non-neutral upper arm postures. The alternative equipment included a slit lamp biomicroscope with inclined viewing oculars, adjustable elbow supports, and a wider tabletop with more room for supporting the arms in comparison to the conventional slit lamp biomicroscope. A wireless binocular indirect ophthalmoscope was also evaluated that had a more even weight distribution than the conventional design. Measurements of upper trapezius and anterior deltoid muscle activity, upper arm posture, and perceived usability were used to compare the conventional and alternative equipment. Results: In comparison to the conventional slit lamp biomicroscope, the alternative slit lamp biomicroscope led to (i) 12% to 13% reductions in upper trapezius muscle activity levels, (ii) a 9% reduction in left anterior deltoid muscle activity levels, and (iii) a 15% reduction in the percentage of work time spent with the left upper arm elevated in positions greater than 60º. In addition, participants rated the comfort and adjustability of both the alternative slit lamp biomicroscope and binocular indirect ophthalmoscope more favorably than the conventional equipment. Conclusions: The results suggest that the alternative slit lamp biomicroscope may help to reduce overall muscular demands and non-neutral postures of the neck and shoulder region among ophthalmologists.

A Survey Study of Musculoskeletal Disorders Among Eye Care Physicians Compared with Family Medicine Physicians

To evaluate the prevalence of musculoskeletal disorders among eye care physicians compared with family medicine physicians. Case control study. Ophthalmologists and optometrists at the University of Iowa and Mayo Clinic (participants) and family medicine physicians at the University of Iowa and Mayo Clinic (controls). An electronic survey was e-mailed to all subjects. The prevalence of musculoskeletal symptoms between eye care providers and family medicine physicians (control group). One hundred eight-six surveys were completed by 94 eye care physicians and 92 family medicine physicians with a response rate of 99% and 80%, respectively. There were no significant differences between the 2 groups with regard to mean age, gender, body mass index, years with current employer, or years in practice. Eye care providers, compared with their family medicine colleagues, reported a higher prevalence of neck (46% vs 21%; P<0.01), hand/wrist pain (17% vs 7%; P = 0.03), and lower back pain (26% vs 9%; P<0.01). A greater proportion of eye care physicians classified their job as a high-strain job (high demand, low control; 31% vs 20%) and a lower proportion classified their job as an active job (high demand, high control; 24% vs 47%; p = 0.01). Several job factors reported by eye care providers to contribute to musculoskeletal symptoms included performing the same task repeatedly, working in awkward/cramped positions, working in the same position for long periods, and bending/twisting the back (all P<0.01). In this survey, the study group, composed of ophthalmologists and optometrists, had a higher prevalence of neck, hand/wrist, and lower back pain compared with family medicine physicians; repetitive tasks, prolonged or awkward/cramped positions, and bending/twisting were contributory factors. Given the ramifications of these findings, future efforts should concentrate on modifications to the eye care providers' work environment to prevent or alleviate musculoskeletal disorders and their personal and socioeconomic burden.

Clinical and microbiological features of acute bacterial conjunctivitis at the primary eye care unit in a hospital of central Italy

Purpose Aim of this study is to identify bacteria causing conjunctivitis in a central Italian area and to analyze their chemosusceptibility. Methods From 2005 to 2006, 91 conjunctival swabs were collected from acute conjunctivitis cases who were examined in the primary eye care unit at the "S. Maria alle Scotte" Hospital in Siena. All swabs collected were screened for common bacteria and fungi. Susceptibility tests were performed on isolates. Results Isolated bacteria were Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae for an amount of 86.2%. Overall, 100% of strains were susceptible to chloramphenicol and 96.6% to quinolones. Conversely, 20.7% of isolates were tetracycline-resistant and, even if all Gram negative isolates were susceptible to gentamicin, more frequently isolated pneumococci are constitutively resistant. Conclusion Acute “red eye” is one of the commonest reasons for consultation with primary eye care physicians; in the majority of cases an acute bacterial conjunctivitis is diagnosed, the pathogens most frequently responsible are Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus. Guidelines on the management of conjunctivitis recommend antibiotic routine use where bacterial infection is suspected. This study provides a support in rational choice of empiric therapy with distinct regional preferences in the topical agent to be used.

Clinical and microbiological features of acute bacterial conjunctivitis at the primary eye care unit in a hospital of central Italy

Abstract Purpose Aim of this study is to identify bacteria causing conjunctivitis in a central Italian area and to analyze their chemosusceptibility. Methods From 2005 to 2006, 91 conjunctival swabs were collected from acute conjunctivitis cases who were examined in the primary eye care unit at the "S. Maria alle Scotte" Hospital in Siena. All swabs collected were screened for common bacteria and fungi. Susceptibility tests were performed on isolates. Results Isolated bacteria were Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae for an amount of 86.2%. Overall, 100% of strains were susceptible to chloramphenicol and 96.6% to quinolones. Conversely, 20.7% of isolates were tetracycline‐resistant and, even if all Gram negative isolates were susceptible to gentamicin, more frequently isolated pneumococci are constitutively resistant. Conclusion Acute “red eye” is one of the commonest reasons for consultation with primary eye care physicians; in the majority of cases an acute bacterial conjunctivitis is diagnosed, the pathogens most frequently responsible are Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus. Guidelines on the management of conjunctivitis recommend antibiotic routine use where bacterial infection is suspected. This study provides a support in rational choice of empiric therapy with distinct regional preferences in the topical agent to be used.

Topical ophthalmic fourth-generation fluoroquinolones: Appropriate use and cost considerations

The utilization and refill rates of topical ophthalmic fourth-generation fluoroquinolones among physicians, as well as the associated costs, were studied. A large data set of retrospective pharmacy prescription claims was obtained from multiple plans, including commercial managed care organizations, Medicaid, and Medicare. The data included the number and cost of all new and refill prescriptions for six months for gatifloxacin 0.3% and moxifloxacin 0.5% by physician specialty. New prescription and refill data were also analyzed from a state Medicaid plan to determine if similar trends existed. Primary care physicians wrote approximately 7,000 (7.7%) gatifloxacin and 84,000 (92.3%) moxifloxacin prescriptions, with pediatricians accounting for 4,000 (5.1%) gatifloxacin and 75,000 (94.9%) moxifloxacin prescriptions. Eye care physicians accounted for a similar amount of prescriptions for each antibiotic during the same period. The total cost of prescriptions for all primary care practitioners was approximately $170,000 for gatifloxacin and $2.5 million for moxifloxacin; prescriptions written by pediatricians accounted for $110,000 for gatifloxacin and $2.2 million for moxifloxacin. Prescription drug claims from payers using pharmacy benefit management companies during a six-month period indicated that the numbers of prescriptions written for gatifloxacin and moxifloxacin were similar among eye care physicians, but primary care physicians wrote a greater number of prescriptions for moxifloxacin. Analysis of claims to a Medicaid database revealed an increase in the prescriptions written by primary care physicians for moxifloxacin after its addition to the drug formulary.

61. Primary ophthalmic care patterns and training of University of Ottawa residentss

This study assessed whether residents are equipped to perform recommended standards of ophthalmic primary care and determined if the findings reflect the adequacy of their undergraduate and postgraduate teaching in ophthalmology. Information was collected using web based online questionnaire that was completed by residents in the residency program at the University of Ottawa. Data was extracted and analyzed using Epi Info software.&#x0D; One hundred and sixteen residents (17% capture rate) in all years of training completed the online questionnaire. Majority of the residents were not familiar with the different vision screening guidelines, less so with the Canadian (63 – 97%) than the American guidelines (91 – 94%). This was reflected in their referral patterns and mixed results of ophthalmic knowledge assessments. Only 21% of respondents were highly confident or confident in dealing with patients with eye problems. However, most were confident in history taking, visual acuity assessment and examination, but less so with ophthalmoscopy and intraocular pressure measurements.&#x0D; The duration of undergraduate ophthalmic clerkship was at least one week in most of the institutions. However, about one third of the residents surveyed did not have any ophthalmology clerkship in medical school. Only 33% felt that their clerkship was adequate and about the same proportion felt that they received adequate ophthalmic exposure of relevance to their current practice. About 90% of the residents have not attended an update course in ophthalmology. Over 75% of the residents thought that a continuing education program in Ophthalmology would be useful and would be interested in attending such a program in the future.&#x0D; Opportunities exist to address these inadequacies to better prepare residents for clinical practice. These include improvements in undergraduate ophthalmic education, inclusion of ophthalmology electives in residency training programs and the development of a continuing education program in ophthalmology for primary eye care physicians.&#x0D; US Preventive Services Task Force: Screening for visual impairment in Children younger than five years: recommendation statement. American Family Physician 2005; 71(2): 333-340.&#x0D; Feightner JW. Routine preschool screening for visual and hearing problems. In: Canadian Task Force on the Periodic Health Examination. Canadian guide to clinical preventive health care. Ottawa: Health Canada, 1994:298-304.&#x0D; Bellan L. Ophthalmology undergraduate education in Canada. Can J Ophthalmol. 1998; 33(1):3 – 7.

Severe Acanthamoeba Keratitis After Overnight Orthokeratology

To document a clinical case of Acanthamoeba keratitis associated with orthokeratology overnight lens wear that resulted in severe, permanent vision loss. Case report. At the age of 11 years, a boy received a spectacle correction for the following refractive error: -3.25 -0.50 x090 in the right eye and -3.50 -0.25 x 040 in the left eye. Alternative wear of daily-wear, disposable, soft contact lenses and rigid gas-permeable lenses was used for athletic activities to the age of 16 years. Between the ages of 16 and 19 years, the patient wore Boston Equalens 2c27 (type Percision Corneal Molding - 51) lenses with a base curve of 9.25, power of +2.50 diopters (D), and diameter of 10.6 mm in the right eye and a base curve of 9.15, power of +3.00 D, and diameter of 10.6 mm in the left eye for overnight orthokeratology wear. A corneal ulcer in the left eye was noted on November 13, 2004 (age of 19 years) and confirmed as Acanthamoeba infection by confocal microscopy on February 15, 2005, when triple topical therapy (Brolene, polyhexamethylbiguanide, and chlorhexidene) was initiated. Vision deteriorated to light perception with accurate projection by cessation of therapy on March 28, 2006. Additional complications included secondary angle-closure glaucoma, treated with an Ahmed tube shunt on April 12, 2005, and a mature cataract. The important message conveyed by this case was the finding that for several years, unknown to his eye care physicians, the patient cleaned his lenses with the Boston Cleaning System, as instructed, but followed this step with a routine rinse with tap water and storage in tap water in his lens case, which was not replaced or cleaned. The tragic loss of vision in this case probably could have been prevented by focused attention to lens hygiene by the patient, parents, and practitioner. Such heightened scrutiny is critically important in orthokeratology rigid lens wear, especially in children, independent of the lens polymer or fitting algorithm used.