Eye Clinic Research Articles

Serum disease-specific IgG Fc glycosylation as potential biomarkers for nonproliferative diabetic retinopathy using mass spectrometry

ObjectiveTo explore the potential of serum disease-specific immunoglobulin G (DSIgG) glycosylation as a biomarker for the diagnosis of nonproliferative diabetic retinopathy (NPDR). MethodsA total of 387 consecutive diabetic patients presenting in an eye clinic without proliferative diabetic retinopathy (DR) were included and divided into those with nondiabetic retinopathy (NDR) (n = 181) and NPDR (n = 206) groups. Serum was collected from all patients for DSIgG separation. The enriched glycopeptides of the tryptic digests of DSIgG were detected using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Patients were randomly divided into discovery and validation sets (1:1). The differences in glycopeptide ratios between the groups were compared by using Student's t-test or the Mann–Whitney U test. The predictive ability of the model was assessed using the area under the receiver operating characteristic curve (AUC). ResultsDSIgG1 G1FN/G0FN, G2N/G2, G2FN/G2N and DSIgG2 G1F/G0F, G1FN/G0FN, G2N/G1N, G2S/G2 were significantly different between NDR and NPDR patients (p < 0.05) in both the discovery and validation sets. The prediction model that was built comprising the seven glycopeptide ratios showed good NPDR prediction performance with an AUC of 0.85 in the discovery set and 0.87 in the validation set. ConclusionDSIgG Fc N-glycosylation ratios were associated with NPDR and can be used as potential biomarkers for the early diagnosis of DR.

Lack of ophthalmology education – is this one of the reasons why our Urgent Eye Clinics are so busy?

Lack of ophthalmology education – is this one of the reasons why our Urgent Eye Clinics are so busy?

Cost-effectiveness of the ADVISE trial: An intraoperative OCT protocol in DMEK surgery.

The intraoperative optical coherence tomography (iOCT) is recently introduced in Descemet membrane endothelial keratoplasty (DMEK) surgery, which aims to increase clinical performance and surgery safety. However, the acquisition of this modality is a substantial investment. The objective of this paper is to report on the cost-effectiveness of an iOCT-protocol in DMEK surgery with the Advanced Visualization in Corneal Surgery Evaluation (ADVISE) trial. This cost-effectiveness analysis uses data 6 months postoperatively from the multicentre prospective randomized clinical ADVISE trial. Sixty-five patients were randomized to usual care (n = 33) or the iOCT-protocol (n = 32). Quality-Adjusted Life Years (EQ-5D-5L), Vision-related Quality of Life (NEI-VFQ-25) and self-administered resources questionnaires were administered. Main outcome is the incremental cost-effectiveness ratio (ICER) and sensitivity analyses. The iOCT protocol reports no statistical difference in ICER. For the usual care group compared with the iOCT protocol, respectively, the mean societal costs are €5027 compared with €4920 (Δ€107). The sensitivity analyses report the highest variability on time variables. This economic evaluation learned that there is no added value in quality of life or cost-effectiveness in using the iOCT protocol in DMEK surgery. The variability of cost variables depends on the characteristics of an eye clinic. The added value of iOCT could gain incrementally by increasing surgical efficiency, and aiding in surgical decision-making.

Botulinum toxin A decreases neural activity in pain-related brain regions in individuals with chronic ocular pain and photophobia.

To examine the effect of botulinum toxin A (BoNT-A) on neural mechanisms underlying pain and photophobia using functional magnetic resonance imaging (fMRI) in individuals with chronic ocular pain. Twelve subjects with chronic ocular pain and light sensitivity were recruited from the Miami Veterans Affairs eye clinic. Inclusion criteria were: (1) chronic ocular pain; (2) presence of ocular pain over 1 week recall; and (3) presence of photophobia. All individuals underwent an ocular surface examination to capture tear parameters before and 4-6 weeks after BoNT-A injections. Using an event-related fMRI design, subjects were presented with light stimuli during two fMRI scans, once before and 4-6 weeks after BoNT-A injection. Light evoked unpleasantness ratings were reported by subjects after each scan. Whole brain blood oxygen level dependent (BOLD) responses to light stimuli were analyzed. At baseline, all subjects reported unpleasantness with light stimulation (average: 70.8 ± 32.0). Four to six weeks after BoNT-A injection, unpleasantness scores decreased (48.1 ± 33.6), but the change was not significant. On an individual level, 50% of subjects had decreased unpleasantness ratings in response to light stimulation compared to baseline ("responders," n = 6), while 50% had equivalent (n = 3) or increased (n = 3) unpleasantness ("non-responders"). At baseline, several differences were noted between responders and non-responders; responders had higher baseline unpleasantness ratings to light, higher symptoms of depression, and more frequent use of antidepressants and anxiolytics, compared to non-responders. Group analysis at baseline displayed light-evoked BOLD responses in bilateral primary somatosensory (S1), bilateral secondary somatosensory (S2), bilateral anterior insula, paracingulate gyrus, midcingulate cortex (MCC), bilateral frontal pole, bilateral cerebellar hemispheric lobule VI, vermis, bilateral cerebellar crus I and II, and visual cortices. BoNT-A injections significantly decreased light evoked BOLD responses in bilateral S1, S2 cortices, cerebellar hemispheric lobule VI, cerebellar crus I, and left cerebellar crus II. BoNT-A responders displayed activation of the spinal trigeminal nucleus at baseline where non-responders did not. BoNT-A injections modulate light-evoked activation of pain-related brain systems and photophobia symptoms in some individuals with chronic ocular pain. These effects are associated with decreased activation in areas responsible for processing the sensory-discriminative, affective, dimensions, and motor responses to pain.

Ocular Complications Associated With Diabetes And The Risk Of Sustainable Blindness; A Real World Analysis.

To evaluate the frequencies of ocular comorbidities among patients with type II diabetes, and the association with multiple systemic factors. The retrospective, cross-sectional study was conducted at the Al Ibrahim Eye Hospital, Karachi, and comprised diabetic eye clinic data from April 2014 to February 2022. Demographic, biochemical and ophthalmic findings of the patients were recorded. Ocular findings analysed were best-corrected visual acuity, lens status, corneal changes, optic disc assessment, intraocular pressure and signs of retinopathy and its grading. Data was analysed using SPSS 22. Of the 43,723 subjects, 22,677(51.86%) were males and 21,046(48.13%). The overall mean age was 54.14±10.68 years. There were 21,680(49.58%) patients with diabetes duration 5-10 years. Overall, 33,876(77.5%), had some ocular morbidity, while 9,847(22.5%) had no such complaints. The commonest morbidity was cataract12,607(28.8%), followed by refractive errors 8,508(19.5%), vision-threatening diabetic retinopathy 2,553(5.83%) and suspected glaucoma 1,211(2.76%). Vision 28 threatening diabetic retinopathy and suspected glaucoma represented sustained blindness risk 3,764(8.6%). Increasing levels of low-density lipoprotein were significantly associated with advanced diabetic eye disease and clinically significant macular oedema (p<0.05), while glycated haemoglobin >6.4 was associated significantly with diabetic retinopathy and suspected glaucoma (p<0.05). Diabetes caused some or the other ocular morbidity that needed intervention. Poor control of biochemical parameters was seen to increase frequency of ocular complications.

Epidemiology of ocular emergencies in a large Canadian eye centre

ObjectifLa clinique ophtalmologique d'urgence de l'Institut oculaire de l'Alberta (EIA, pour Eye Institute of Alberta) est un centre de soins tertiaires qui procure des soins ophtalmologiques d'urgence à une population de plus de 1 million de personnes. Notre étude avait pour objectif de décrire l’épidémiologie des urgences oculaires de cette clinique. NatureÉtude épidémiologique prospective fondée sur une utilisation secondaire des données de patients. ParticipantsTous les patients examinés à la clinique ophtalmologique d'urgence de l'EIA en semaine de juillet 2020 à juin 2021. MéthodesLes données démographiques des patients, le motif d'orientation vers la clinique, les diagnostics finaux, les besoins en matière d'imagerie, les interventions d'urgence ou les renvois ultérieurs vers une autre ressource médicale ont été tirés des dossiers des patients. Le logiciel SPSS Statistics a servi à réaliser l'analyse des données. RésultatsAu total, 2586 patients ont été examinés pendant la période à l’étude. Dans la plupart des cas (58 %), ce sont des urgentologues qui ont adressé les patients à la clinique. Les optométristes et les généralistes, pour leur part, ont adressé 14 % et 11 % des patients, respectivement. La plupart des diagnostics des patients ainsi dirigés à la clinique relevaient d'une inflammation (32 %) et d'un traumatisme (22 %). Les cas d'inflammation se déclinaient comme suit : 41 % d'infections oculaires et 8 % d'infections des annexes oculaires. De plus, 44 % et 7 % des cas présentaient une inflammation non infectieuse des yeux et des annexes oculaires, respectivement. Au nombre des interventions d'urgence souvent réalisées, citons le retrait d'un corps étranger dans la cornée ou la conjonctive (39 %) et le grattage cornéen (14 %). ConclusionsLes urgentologues, les généralistes et les optométristes pourraient tirer grand profit d'une formation continue sur les soins oculaires d'urgence portant sur les catégories diagnostiques les plus fréquentes, comme l'inflammation et les traumatismes. Il serait également être utile de mettre sur pied des programmes de formation ciblée à l'intention du grand public sur la prévention des traumatismes et des infections, qui feraient par exemple la promotion du port de lunettes de protection et de l'hygiène des lentilles cornéennes.

Hubungan konsep diri dengan mekanisme koping pada pasien post operasi glaukoma di poli mata RSUD Meuraxa Banda Aceh tahun 2022

Background: physical conditions can affect patients in forming their self-concept, patients who have a good self-concept will respect themselves, accept themselves, and do not underestimate themselves and recognize their limitations. Conversely, patients who have a poor self-concept will generally avoid their environment, tend to be alone and dissatisfied with themselves.Objectives: to determine the relationship between self-concept and coping mechanisms in postoperative glaucoma patients at the Eye Clinic at Meuraxa Hospital, Banda Aceh.Methods: this type of quantitative research with the correlation method and using the Cross Sectional Study approach. Sampling using non-probability sampling with purposive sampling technique. The number of samples was 39 patients who underwent glaucoma surgery.Results: the results of bivariate analysis showed the value of ρ = 0.002 and α = 0.05, which means that the value of p &lt; α Ho was rejected and Ha was accepted. This means that there is a relationship between self-concept and coping mechanisms in postoperative glaucoma patients at the Eye Clinic at Meuraxa Hospital.Conclusion: that the better the patient's self-concept, the coping used is adaptive.

Effect of diabetic macular oedema on serum iron status indicators

ABSTRACT Clinical relevance The role of subclinical inflammation in the pathophysiology of diabetic macular oedema (DME), which is known to be quite complex, is of much interest. Serum ferritin level, which is an indicator of body iron stores, is both an inflammatory marker for various neurodegenerative diseases and an important indicator in the evaluation of iron-induced oxidative stress. Background Iron metabolism indicators play a role in the formation and development of diabetic retinopathy, which is known to be associated with subclinical inflammation, and may also play a role in the pathogenesis of DME. The aim of this study was to investigate the role of serum iron metabolism markers in the pathogenesis of DME. Materials and methods The files of all nonproliferative diabetic retinopathy (NPDR) patients who were scheduled for the first intravitreal injection for DME in the eye clinic between January 2019 and January 2020 were reviewed retrospectively. By examining the files of all diabetes mellitus patients who attended the outpatient eye clinic on the same dates, those without retinopathy and those with NPDR but not DME were recorded. All results, including a comprehensive ophthalmological examination, laboratory data of fasting blood tests, and an internal medicine outpatient examination were collected for analysis. Results Of the 157 participants, 44 were NPDR patients with oedema, 50 were NPDR patients without oedema, and 63 were patients without retinopathy. There was a significant difference between the groups in respect of creatinine, high-density lipoprotein, mean corpuscular volume, serum iron and ferritin, total iron binding capacity and transferrin saturation (p < 0.050). Ferritin values were found to be significantly higher in patients with macular oedema. Other iron status markers were found to be significantly lower (p < 0.050). Conclusion Evaluation of serum iron status indicators in the routine follow-up of diabetic patients may be of diagnostic and/or prognostic benefit in terms of DME.

Safety and efficacy in pediatric secondary intraocular lens implantation, in-the-bag versus sulcus implantation: a multicenter, single-blinded randomized controlled trial

BackgroundTreatment of pediatric cataract remains challenging because of the extremely high incidence of postoperative adverse events (AEs), especially the AEs related to the locations of secondary implanted intraocular lens (IOL). There are two common locations for secondary IOL implantation in pediatric aphakic eyes: ciliary sulcus or in-the-bag implantation. However, there are currently no large, prospective studies comparing complication rates and visual prognosis of in-the-bag versus ciliarysulcus secondary IOL implantation in pediatric patients. Whether or how much secondary in-the-bag IOL implantation benefits the pediatric patients more than sulcus implantation and deserves to be performed routinely by surgeons remains to be elucidated. Here, we describe the protocol of a randomized controlled trial (RCT) designed to evaluate the safety and efficacy of two approaches of IOL implantation in pediatric aphakia.MethodsThe study is a multicenter, single-blinded RCT with 10 years of follow-up. Overall, a minimum of 286 eyes (approximately 228 participants assuming 75% have two study eyes) will be recruited. This study will be carried out in four eye clinics across China. Consecutive eligible patients are randomized to undergo either secondary in-the-bag IOL implantation or secondary sulcus IOL implantation. Participants with two eyes eligible will receive the same treatment. The primary outcomes are IOL decentration and the incidence of glaucoma-related AEs. The secondary outcomes include the incidence of other AEs, IOL tilt, visual acuity, and ocular refractive power. Analysis of the primary and secondary outcomes is to be based on the intention-to-treat and per-protocol analysis. Statistical analyses will include the χ2 test or Fisher’s exact test for the primary outcome, mixed model and generalized estimated equation (GEE) model for the secondary outcome, Kaplan–Meier survival curves for the cumulative probability of glaucoma-related AEs over time in each group.DiscussionTo the best of our knowledge, this study is the first RCT to evaluate the safety and efficacy of secondary IOL implantation in pediatric aphakia. The results will provide high-quality evidence for the clinical guidelines for the treatment of pediatric aphakia.Trial registrationClinicalTrials.gov NCT05136950. Registered on 1 November 2021.

Comparison of Blood Levels of Vitamin B12, Folic Acid (B9), Riboflavin (B2), and Homocysteine in Keratoconus and Healthy Subjects.

Blood levels of vitamin B12, folic acid (B9), riboflavin (B2), and homocysteine were evaluated in keratoconus (KC) and healthy subjects. Eskişehir Osmangazi University. Cross-sectional study. In this prospective study, 100 KC patients (patient group) between the ages of 18-35 years and 200 healthy individuals (control group) in the same age range were included in the Eskişehir Osmangazi University (ESOGÜ) Hospital Eye Clinic between October 2019 and March 2020. In all cases, a complete ophthalmologic examination and corneal tomography evaluation with a Pentacam Scheimpflug camera were performed. In blood samples, vitamin B12 and folic acid levels were measured using an electrochemiluminescence immunoassay analyzer, and homocysteine and riboflavin levels were measured using high-performance liquid chromatography. Chi-square tests were used in the analysis of categorical variables, and Mann-Whitney U and Kruskal-Wallis tests were used in the analysis of numerical variables. Homocysteine (13.0±6.6 vs 12.1±5.4 µmol/L, p=0.190), vitamin B12 (313.5±119.4 vs 322.9±128.3 pg/mL, p=0.619), folic acid (7.0±2.7 vs 7.4±2.9 ng/mL, p=0.230) levels were not different between KC and control groups. The mean riboflavin level was 84.0 ± 21.8 µg/L in the patient group and 183.6±74.3 µg/L in the control group, with a significant difference between the two groups ( p <0.001). Riboflavin levels were below 180 µg/L in 99% (n=99) of the cases in the KC group and 53.5% (n=107) in the control group ( p <0.001). Low blood riboflavin levels in KC patients may be a possible risk factor in the pathogenesis of KC.

A multicenter phase II study on the safety of rho-kinase inhibitor (ripasudil) with needling for the patients after trabeculectomy

BackgroundThere is no established method of maintaining or reducing intra ocular pressure after the needling procedure for failing blebs post trabeculectomy. Regarding newer antihypertensive medications, ripasudil, which is a rho-associated protein kinase inhibitor ophthalmic solution, was able to prevent excessive scarring in vitro. This study aims to evaluate the safety of glaucoma patients submitted to the needling procedure and administered ripasudil for preventing scarring after the procedure. We also investigate the efficacy of ripasudil after needling for bleb failure through suppression of fibrosis to the bleb. MethodsThis study is a multicenter, open-label, single-arm, phase II trial to evaluate the safety and efficacy of ripasudil in glaucoma patients after the needling procedure. Forty patients who will undergo needling at least 3 months after trabeculectomy will be recruited in Hiroshima university hospital and Hiroshima eye clinic. All the patients will instill ripasudil two times per day for three months after the needling procedure. The primary endpoint is the safety of ripasudil. ConclusionsWe plan to establish the safety of ripasudil and to collect information involving the efficacy of ripasudil widely in this study.

Age Associations with Dry Eye Clinical Signs and Symptoms in the Dry Eye Assessment and Management (DREAM) Study.

To evaluate how increasing age is associated with dry eye disease (DED) signs and symptoms in the Dry Eye Assessment and Management (DREAM) study. This study was undertaken to better understand how DED signs and symptoms differ across decades of life with goals to help assess detection and treatment of DED. Secondary analysis of the DREAM study. One hundred twenty, 140, 185, and 90 participants aged < 50, 50 to 59, 60 to 69, and ≥ 70 years, respectively. We performed a secondary analysis of data from the DREAM study, a multicenter randomized clinical trial, to evaluate the effect of omega-3 fatty acid supplementation for the treatment of DED. At baseline, 6 months, and 12 months follow-up, participants underwent an assessment of DED symptoms and signs using Ocular Surface Disease Index, Brief Pain Inventory, tear break-up time (TBUT) (in seconds), Schirmer test with anesthesia (mm/5 minutes), conjunctival staining, corneal staining, meibomian gland dysfunction evaluation, and tear osmolarity (mOsm/l). Multivariable generalized linear regression models were used to compare DED symptoms and signs across the 4 age groups among all participants and by sex. Scores of DED symptoms, individual signs, and composite scores of DED signs. Among 535 patients with DED, increasing age was significantly associated with worse TBUT (P=0.01), corneal staining (P < 0.001), a composite severity score of DED signs (P= 0.007), and tear osmolarity (P= 0.001). Similar significant differences were found across 4 age groups of 334 women in TBUT, corneal staining score, composite severity score of DED signs, and tear osmolarity (all P < 0.05) but not in men. We found that corneal staining, TBUT, tear osmolarity, and a composite severity score of DED signs were significantly more severe with increasing age in women but not in men; worsening symptoms did not increase with increasing age. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Level of Eye Care Among Eye Care Providers Themselves.

To assess the prevalence of eye disease and frequency of eye examinations among eye care providers themselves. In this cross-sectional study, an anonymous questionnaire was used to evaluate occurrence of eye disease and frequency of eye examinations among eye care providers including the clinicians (ophthalmologists, ophthalmology residents, and optometrists) as well as the support staff (ophthalmic technicians and eye clinic administrative staff). The survey response rate was 98 of 173 (56.6%) including 50 ophthalmic technicians, 27 ophthalmologists, 7 ophthalmology residents, 6 optometrists, and 8 eye clinic administrative staff members. The most common reported ocular condition was dry eye disease (36.7%). Myopia and hyperopia were present in 60 (61.2%) and 13 (13.3%), respectively. Myopia was significantly more prevalent among the clinicians (75.0%) than in the support staff (51.7%, P =0.02). The most recent eye examination was within the past year in 42 (42.9%), 1 to 2 years in 28 (28.6%), 3 to 5 years in 14 (14.3%), and over 5 years in 10 (10.2%). Four (4.1%) had never had an eye examination before. The number of eye examinations received was significantly higher in the support staff compared with the clinicians for the past one year (0.86±0.74 vs 0.43±0.59, respectively, P =0.003) and the past five years (2.81±2.08 vs 1.75±1.78, respectively, P =0.01). Dry eye disease and myopia are common among eye care providers. A significant portion of eye care providers do not have regular eye examinations for themselves.

Can the diagnostic accuracy of newborn eye screening for congenital cataract be improved with digital imaging? The Digital Imaging versus Ophthalmoscopy (DIvO) study

Background Congenital cataract is the commonest cause of preventable child blindness in the world. It affects 1: 3000 babies, 60% of whom will have bilateral disease. Although screening of the newborn red-reflex with an ophthalmoscope is recommended, there are questions over this technique's accuracy, particularly in non-specialist hands. Several studies in enriched paediatric eye clinic populations have demonstrated superior accuracy when a digital image of the the eye's reflection to infrared light is evaluated. Aim This study uses a prototype infrared digital camera to test the hypothesis that the sensitivity and specificity of newborn screening using evaluation of the "infrared-reflex" image is superior to the standard red-reflex examination using ophthalmoscopy. Methods 140,000 newborn babies will be recruited into the study from at least 13 maternity units in England over an 18 month period. Babies will have both the standard red-reflex assessment and evaluation of the infrared-reflex using a prototype device. Since specialist gold-standard evaluation of every participant is impractical, bespoke data linkage requests to NHS England will be made. Data from the red-reflex evaluation and the presence of codes relating to cataract diagnosis and/or treatment in Hospital Episode Statistics (HES) will be retrieved for each participant a minimum of 6 months after their birth. This data will be used to calculate relative and absolute sensitivity and specificity for each screening test and comparison of accuracy using the McNemar test. Secondary outcome measures will include comparison of accuracy in different ethnic groups and screener usability scores. Anticipated impact Confirmation of the hypothesis will support development of a commercial screening device and the possible revision of newborn screening recommendations. Trial registration The study is registered with clinicaltrials.gov: NCT05282147.

Spectrum of ocular disease in children aged between 0 and 3 years at an Australian paediatric tertiary hospital.

Childhood ocular disease can be a significant health burden to the child, family and society. Previous studies have examined the spectrum of paediatric ocular disease presenting to tertiary hospitals; however, these studies have broader age ranges, smaller sample sizes, and are largely based in developing countries. This study aims to assess the spectrum of ocular disease in the first 3 years of life presenting to the eye department of an Australian tertiary paediatric hospital. The records of 3337 children who had their initial presentation at the eye clinic between the age of 0 and 36 months were reviewed, spanning 6.5 years from 1st July 2012 to 31st December 2018. The most common primary diagnoses overall were strabismic amblyopia (6.0%), retinopathy of prematurity (5.0%) and nasolacrimal duct obstruction (4.5%). Bilateral visual impairment was more common in younger children, while unilateral visual impairment was more common in older children. The proportion of all children presenting with visual impairment was 10.3%, with 5.7% of all children presenting with bilateral visual impairment and 4.6% presenting with unilateral visual impairment. In children with visual impairment, the most common sites of primary abnormality were lens (21.4%), retina (17.3%), and cerebral and visual pathways (12.1%). The most common primary diagnoses in children with visual impairment were cataract (21.4%), strabismic amblyopia (9.3%) and retinoblastoma (6.5%). The spectrum of eye disease and vision impairment presenting in the first 3 years of life facilitates health care planning, greater community education about vision impairment and importance of early intervention, and guidance for appropriate resource allocation. Health systems can apply these findings to aid in early identification and intervention to reduce preventable blindness and institute appropriate rehabilitation services.

Refractive results after cataract surgery in patients: calculation with Holladay II and Barrett Universal II formulas

The refractive result is a criterion for the quality of surgical correction of cataract. The aim of this study was to analyze the refractive results obtained in calculating the optical power of intraocular lens (IOL), by applying the formulas Holladay II and Barrett Universal II, in the treatment of patients. The study was conducted over a period of 2 years and analyzed the results obtained in 235 eyes of 160 patients (80 women and 80 men) who underwent surgery at the MMA Eye Clinic (Sofia) between May 2018 and December 2020. A complete ophthalmological examination was performed. Surgical methods included performing uncomplicated phacoemulsification with intracapsular implantation of intraocular lens (IOL) in all patients. The effectiveness of the applied surgical procedure was determined by the implementation of the intended postoperative result (Target) and achieved postoperative uncorrected visual acuity (UCVA). A month after operation in 49 eyes (85.1%) the UCVA was over 0.8, which is a very good postoperative result. In both applied formulas, the postoperative, refractive results were best in eyes of normal axial length, followed by cases of hyperopic refraction. There was greater inaccuracy in eyes with longer axial length, and lastly there were eyes with hyperopic refraction. The obtained results support the understanding that there is currently no ideal formula to give the desired, postoperative refraction for all eye types. The analysis of postoperative results is essential for modern medical practice.

Validation of an Automated Symptom-Based Triage Tool in Ophthalmology.

Acute care ophthalmic clinics often suffer from inefficient triage, leading to suboptimal patient access and resource utilization. This study reports the preliminary results of a novel, symptom-based, patient-directed, online triage tool developed to address the most common acute ophthalmic diagnoses and associated presenting symptoms. A retrospective chart review of patients who presented to a tertiary academic medical center's urgent eye clinic after being referred for an urgent, semi-urgent, or nonurgent visit by the ophthalmic triage tool between January 1, 2021 and January 1, 2022 was performed. Concordance between triage category and severity of diagnosis on the subsequent clinic visit was assessed. The online triage tool was utilized 1,370 and 95 times, by the call center administrators (phone triage group) and patients directly (web triage group), respectively. Of all patients triaged with the tool, 8.50% were deemed urgent, 59.2% semi-urgent, and 32.3% nonurgent. At the subsequent clinic visit, the history of present illness had significant agreement with symptoms reported to the triage tool (99.3% agreement, weighted kappa = 0.980, p < 0.001). The triage algorithm also had significant agreement with the severity of the physician diagnosis (97.0% agreement, weighted kappa = 0.912, p < 0.001). Zero patients were found to have a diagnosis on exam that should have corresponded to a higher urgency level on the triage tool. The automated ophthalmic triage algorithm was able to safely and effectively triage patients based on symptoms. Future work should focus on the utility of this tool to reduce nonurgent patient load in urgent clinical settings and to improve access for patients who require urgent medical care.

A case of sclerochoroidal calcification masquerading as a retained intraocular foreign body

A 41-year-old, New Zealand European male, was seen in the acute eye clinic as an in-patient from the trauma ward with multiple comorbidities including an orbital fracture from injuries sustained in a road traffic accident. It is not uncommon in emergency settings for emergency physicians to review polytrauma patients prior to Ophthalmologists, with Computerized Tomography being the imaging modality of choice. A hyper-dense lesion within the right globe was noted by radiology at the time and concerns were raised about the possibility of a retained intraocular foreign body. Upon Ophthalmic examination, a clinical diagnosis of sclerochoroidal calcification was made. This case highlights a rare case of sclerochoroidal calcification manifesting as a hyperdense lesion on computerized tomography masquerading as an intraocular foreign body.

Evaluation of Implantable Collamer Lens Sizing Developed by Reviewing the Horizontal Compression-vault Coefficient.

To evaluate the implantable collamer lens (ICL) sizing method using the partial regression coefficient of the implanted ICL size to review the conventional horizontal compression coefficient and match the results of clinical observation. Nagoya Eye Clinic, Nagoya, Japan. Interventional case series. Patients who underwent ICL V4c implantation to correct myopia and myopic astigmatism were enrolled. The stepwise multiple regression analysis used achieved vault as a dependent variable and preoperative biometric parameters as explanatory variables. The partial regression coefficient of the implanted ICL size was obtained to develop the optimal ICL-sizing formula, the NK-formula version 3 (NK-formula V3). Eighty-five eyes of 45 patients were implanted with an ICL size recommended by the NK-formula V3. At 3 months postoperatively, the achieved vault was measured using AS-OCT to validate the NK-formula V3. The study enrolled 174 patients (174 eyes). The partial regression coefficient of the implanted ICL size adopted as the compression-vault coefficient in the multiple regression equation predicting the vault was 0.729. To validate the NK-formula V3, 77 (90.6%), seven (8.2%), and one (1.2%) eye were in the moderate, low, and high vault categories, respectively. The mean difference between the achieved and predicted vault was 0.064±0.190 (range: -0.264-0.742) mm for the NK-formula V3 and 0.176±0.217 (range: -0.254-0.907) mm for the NK-formula V2. As in vivo coefficient measurement experiments are not possible, the partial regression coefficient is the best option for developing a formula to predict the optimal ICL size.

Efficacy and Safety of 6-Weekly versus 12-Weekly Intravenous Methylprednisolone in Moderate-to-Severe Active Thyroid-Associated Ophthalmopathy.

To compare the efficacy and safety of 6-weekly and 12-weekly intravenous methylprednisolone (IVMP) regimens in moderate-to-severe, active thyroid-associated orbitopathy (TAO) patients. Retrospective comparative study of patients who received IVMP between January 2011 and July 2021 at the Thyroid Eye Clinic, the Chinese University of Hong Kong. Outcome measures included the 7-item clinical activity score (CAS), exophthalmos, extraocular muscle motility (EOMy), marginal reflex distance (MRD), best corrected visual acuity (BCVA), intraocular pressure (IOP), the requirement of additional treatment, and complications. A total of 65 (63% (41/65) females) moderate-to-severe, active TAO patients aged 50 ± 13 (25-74) years received 6-weekly (n = 22) or 12-weekly (n = 43) IVMP. Sex, age, smoking status, and Graves' disease status were comparable in the two groups (all p > 0.05). CAS at week 6 (p = 0.0279), 12 (p = 0.00228), and 52 (p = 0.0228) were lower at each time for the 12-weekly group. Exophthalmos improved more at week 6 (p = 0.0453) and 12 (p = 0.0347) in the 12-weekly group. The improvement of diplopia, MRD1, MRD2, and EOMy were comparable between the two groups. More patients in the 6-weekly group (p = 0.00169) required additional treatments including IVMP+/-ORT. Patients in the 6-weekly group who did not require additional treatment had a lower presenting CAS (p = 0.0193) than those who required additional treatment. The total numbers of adverse events were comparable between the two groups.