General Ophthalmology Research Articles

Consenso Latinoamericano de Lubricantes Oculares y Ojo Seco (LUBOS)

The tear film has a complex composition allowing it fulfill multiple functions, such as optical, lubrication, immunological, endocrine, and neurotrophic, which are relevant for visual health. Alterations in its components, both in quality and quantity, will affect its homeostasis, also impacting the ocular surface, leading to a condition known as “dry eye”. Dry eye has a high global prevalence, which is further increasing due to environmental factors (mainly screen mainly) and the overall rise in life expectancy. Several products are available for its treatment, but lubricants, generally referred to as “artificial tears”, continue to be crucial. There is a wide variety of lubricant formulations with different indications, which, when used appropriately according to the type and severity of dry eye, allow for effective customized treatment. Considering the complexity and relevance of this issue, the Latin American Study Group on Lubricants and Dry Eye (LUBOS) was formed. This work represents a consensus with the aim of creating a diagnostic and therapeutic algorithm for dry eye, focused on the proper use of lubricants, providing practical guidance for general ophthalmologists.

Evaluating the Effect of Image Enhancement on Diagnostic Reliability in Dry Eye Disease Using a Portable Imaging Device.

This study aimed to evaluate the impact of image enhancement techniques on the interobserver reliability of tear break-up time (TBUT), tear meniscus height (TMH), corneal fluorescein staining (CFS) scoring, and conjunctivochalasis detection using the Smart Eye Camera (SEC), a portable device for anterior segment examination. A retrospective analysis was conducted on video recordings captured by the SEC from 46 patients with dry eye disease (DED). Separate sets of images were created for each level of enhancement: unenhanced (G0), mildly enhanced (G3), and strongly enhanced (G7). These sets were not intermixed, ensuring that each enhancement level was assessed independently. Three observers-two DED specialists and one general ophthalmologist-assessed TBUT, TMH, CFS scores, and conjunctivochalasis. Interobserver reliability was evaluated using intraclass correlation coefficients (ICCs) for each image set. Interobserver reliability for CFS scores significantly improved with G3, yielding an ICC of 0.8413. In contrast, G7 improved reliability for TBUT measurements (ICC = 0.7381), but led to a notable decrease in reliability for both CFS scoring (ICC = 0.2259) and conjunctivochalasis detection (ICC = 0.0786). Furthermore, the assessment of TMH demonstrated a progressive decline in accuracy with increasing levels of image enhancement. Image enhancement using the SEC improved the diagnostic consistency of dry eye specialists and general ophthalmologists, especially for TBUT and CFS assessments. However, excessive enhancement may obscure key diagnostic features, indicating the need for careful optimization of image processing techniques depending on the diagnostic focus.

Efficacy of a portable non-mydriatic fundus camera for "rule-out papilledema" consultations: A prospective study.

Ophthalmology is frequently consulted to "rule-out papilledema." We assessed the efficacy of a portable, non-mydriatic fundus camera in detecting optic disc edema in the inpatient and emergency room settings during "rule-out papilledema" consultations, comparing to the gold standard dilated fundus examination (DFE). This prospective, blinded, cohort study included 124 non-mydriatic fundus photographs (62 patients) that were obtained over the 11-month enrollment period. The images, along with a brief clinical history, were evaluated independently by an attending neuro-ophthalmologist (NO), general ophthalmologist (GO), emergency room (ER) physician, and ophthalmology resident (OR), for the presence of disc edema and indication for consultation. Results were compared to DFE. Sensitivity, specificity, and area under receiver operating characteristic (ROC) curves were determined to evaluate the efficacy of the camera. On DFE, disc edema was present in 51 eyes (41.1%). Compared to DFE, NO assessment had the greatest combined sensitivity (84.3%) and specificity (97.3%) for the detection of disc edema, followed by that of GO (sensitivity 77.4%, specificity 100%), OR (sensitivity 96.1%, specificity 80.8%), and ER clinician (sensitivity 68.6%, specificity 89.0%). Areas under ROC curves for NO, GO, OR, and ER physician were all statistically significant for the detection of disc edema (0.908, P < 0.001; 0.892, P < 0.001; 0.885, P < 0.001; 0.788, P < 0.001, respectively). Clinicians were able to correctly identify optic disc edema using non-mydriatic fundus photography. Non-mydriatic fundus photography may be an effective inpatient or telemedicine tool to assess for optic disc edema.

Cost-Effectiveness of a Telemedicine Optometric-Based Assessment for Screening Diabetic Retinopathy in a Country with a Universal Public Health System.

Objective: To determine the cost-effectiveness of a new telemedicine optometric-based screening program of diabetic retinopathy (DR) compared with traditional models' assessments in a universal European public health system. Methods: A new teleophthalmology program for DR based on the assessment of retinographies (3-field Joslin Vision Network by a certified optometrist and a reading center [IOBA-RC]) was designed. This program was first conducted in a rural area 40 km from the referral hospital (Medina de Rioseco, Valladolid, Spain). The cost-effectiveness was compared with telemedicine based on evaluations by primary care physicians and general ophthalmologists, and to face-to-face examinations conducted by ophthalmologists. A decision tree model was developed to simulate the cost-effectiveness of both models, considering public and private costs. The effectiveness was measured in terms of quality of life. Results: A total of 261 patients with type 2 diabetes were included (42 had significant DR and required specific surveillance by the RC; 219 were undiagnosed). The sensitivity and specificity of the detection of DR were 100% and 74.1%, respectively. The telemedicine-based DR optometric screening model demonstrated similar utility to models based on physicians and general ophthalmologists and traditional face-to-face evaluations (0.845) at a lower cost/patient (€51.23, €71.65, and €86.46, respectively). Conclusions: The telemedicine-based optometric screening program for DR in a RC demonstrated cost savings even in a developed country with a universal health care system. These results support the expansion of this kind of teleophthalmology program not only for screening but also for the follow-up of diabetic patients.

A Systematic Review of Teleophthalmology Services Post-COVID-19 Pandemic in New Zealand, the United Kingdom, Australia, the United States of America, and Canada.

Background: This systematic review of teleophthalmology services in Australia, the United States of America (USA), Canada, and the United Kingdom (UK) during the COVID-19 pandemic is aimed to evaluate changes in teleophthalmology, comparing them to New Zealand (NZ). Methods: A literature search of electronic databases Scopus, Proquest, PubMed, Embase, Web of Science, Cochrane Library, Google Scholar, and Google was conducted using search terms: telemedicine, ophthalmology, teleophthalmology/teleophthalmology, and COVID/COVID-19/coronavirus/covid-pandemic. Studies describing teleophthalmology services created in response to COVID-19 restrictions from March 1, 2020, to January 31, 2024, were analyzed. Results: Of the articles, 37 describing 29 discrete teleophthalmology services were included. There were 15 services in the USA, seven in the UK, two in Canada, two in Australia, and three in NZ. The models of care in the USA were well described, and teleophthalmology was used for general, external, anterior segment, neuro-ophthalmology, and oculoplastic consults, as well as for grading of fundus images in the emergency department setting. In the UK, teleophthalmology was used for general eye care, oculoplastics, and pediatric ophthalmology. In Australia, teleophthalmology was used for postglaucoma surgery monitoring of Intraocular Pressure. In NZ, teleophthalmology was used for general eye consults and triaging, but no formal models were described. Conclusion: COVID-19 offered a unique opportunity for re-examination and expansion of teleophthalmology services globally. Video-based and home-screening teleophthalmology services are feasible but have limitations. Investing in multidisciplinary and community-based technology partnerships can create more equitable teleophthalmology care models (to complement and, when necessary, replace traditional in-person consults), within existing frameworks, making eye care more accessible and efficient.

Clinical Course and Pattern of Uveitis in Western Iran

Background: Demographic characteristics apparently play a critical role in the incidence and prevalence of uveitis in different societies. Numerous studies have investigated the demographic-epidemiological factors and clinical patterns of uveitis in Iran; however, no study has been conducted in the west of the country yet. Objectives: To assessed epidemiologic pattern of uveitis in patients residing in the west of Iran. Methods: This study investigated 358 files of uveitis patients referring to the specialized retina-uveitis clinics in a referral hospital in the west of Iran from March 2016 to September 2022. The demographic characteristics, clinical patterns, and complications of uveitis were evaluated in this study. Results: The uveitis patients’ mean age (± SD) at the diagnosis time was 48.14 (± 11.91) years (18 - 72 years), the patients with anterior uveitis had the lowest mean age (45.47 ± 11.54 years), and the patients with panuveitis had the highest mean age (52.90 ± 10.14 years) at the diagnosis time. The prevalence of the disease was equal in both genders; however, posterior uveitis and panuveitis significantly involved males more than females (P &lt; 0.01 and 0.01 respectively). The most common anatomical pattern of involvement belonged to anterior uveitis (34%), followed by panuveitis (23.4%), posterior uveitis (22.9%), and intermediate uveitis (19.5%). The prevalent etiology in anterior, intermediate, and panuveitis were idiopathic and Toxoplasma chorioretinitis was the most common causes in posterior uveitis (34.14%). Moreover, acute clinical course and non-granulomatous pathology were also more prevalent. The most common complications of the disease were cataracts and cystoid macular edema (CME). Also, patients with panuveitis followed by posterior uveitis had the worse visual prognosis. Conclusions: The predominant pattern of involvement in patients referring to the referral center in the west of Iran was in the form of anterior uveitis, acute in terms of clinical course, and non-granulomatous in terms of pathology. This clinical view for evaluation in a referral center differs from the pattern expected to be observed in the general population and even in general ophthalmology centers.

Application of Convolutional Gated Recurrent Units U-Net for Distinguishing between Retinitis Pigmentosa and Cone–Rod Dystrophy

Abstract Artificial Intelligence (AI) has gained a prominent role in the medical industry. The rapid development of the computer science field has caused AI to become a meaningful part of modern healthcare. Image-based analysis involving neural networks is a very important part of eye diagnoses. In this study, a new approach using Convolutional Gated Recurrent Units (GRU) U-Net was proposed for the classifying healthy cases and cases with retinitis pigmentosa (RP) and cone–rod dystrophy (CORD). The basis for the classification was the location of pigmentary changes within the retina and fundus autofluorescence (FAF) pattern, as the posterior pole or the periphery of the retina may be affected. The dataset, gathered in the Chair and Department of General and Pediatric Ophthalmology of Medical University in Lublin, consisted of 230 ultra-widefield pseudocolour (UWFP) and ultra-widefield FAF images, obtained using the Optos 200TX device (Optos PLC). The data were divided into three categories: healthy subjects (50 images), patients with CORD (48 images) and patients with RP (132 images). For applying deep learning classification, which rely on a large amount of data, the dataset was artificially enlarged using augmentation involving image manipulations. The final dataset contained 744 images. The proposed Convolutional GRU U-Net network was evaluated taking account of the following measures: accuracy, precision, sensitivity, specificity and F1. The proposed tool achieved high accuracy in a range of 91.00%–97.90%. The developed solution has a great potential in RP diagnoses as a supporting tool.

Consensus recommendations for the assessment and management of idiopathic intracranial hypertension in children and young people

BackgroundIdiopathic intracranial hypertension (IIH) is a potentially disabling condition. There is a lack of evidence and national guidance on how to diagnose and treat paediatric IIH, leading to variation in...

Automated Optic Nerve Head Hemoglobin Measurements versus General Ophthalmologists Evaluation to Differentiate Glaucomatous from Large Physiological Cupping: A Diagnostic Performance Comparative Study.

The aim of this study is to compare the diagnostic performance in differentiating patients with glaucoma from those with presumed large physiological optic disc cupping (LPC), using optic nerve head hemoglobin levels (ONH Hb), as a screening method, versus the evaluation of general ophthalmologists. Twenty general ophthalmologists evaluated PowerPoint images of 40 patients with glaucoma and 40 presenting LPC. Presentation of patient's exams were distributed as follows: Group 1 (GI): color retinography (CR), Group 2 (GII): CR + visual field (VF), Group 3 (GIII): CR + optical coherence tomography (OCT), Group 4 (GIV): CR + VF + OCT. The Laguna ONhE software was used to estimate ONH Hb based on CR. Main outcomes were the comparison of sensitivity and accuracy between general ophthalmologists' evaluation and the glaucoma discriminant function (GDF) index from Laguna ONhE and also the agreement between examiners (Kappa statistics). Laguna ONhE GDF index demonstrated higher sensitivity values (GI- 90%; GII-90%; GIII-100%; GIV-100%) comparing to all groups (GI-59%; GII-86.5%; GIII-86.5%; GIV-68.5%). In GI, in which it was observed the worst accuracy result (64.8%), we found 75% for GDF. In GII, the accuracy was 81.3% and we found 55% for GDF. The highest agreement was in GII (Kappa=0.63; 95% CI=0.53-0.72), and the lowest in GI (Kappa=0.30; 95% CI=0.20-0.39). Laguna ONhE software, a low-cost and non-invasive method, showed good sensitivity and great utility as a screening method in differentiating patients with glaucoma from those with LPC, compared with evaluation of general ophthalmologists.

Artery of Percheron infarct – An ophthalmologist’s perspective

Thalamus is an important relay station in diencephalon which receives its blood supply mostly from the posterior cerebral artery. The Artery of Percheron (AOP) arises from the posterior cerebral artery and bifurcates to supply paramedian thalami. AOP infarction, though rare, presents with a triad of clinical features including altered mental status, memory impairment, and supranuclear vertical gaze palsy. Our patient had concurrent manifestation of vertical gaze palsy (both upward and downward) and third cranial nerve palsy in the left eye, which is an interesting clinical amalgamation. Our case report elucidates the quick recognition of the abnormalities in ocular motility through a simple, yet effective nine gaze ocular motility evaluation and thereby enhancing clinical recognition of this entity among the practicing general Ophthalmologists.

The Use of Non-Person-First Language in Consecutive General Ophthalmology Referrals

To investigate the prevalence of non-person-first language (PFL) in consecutive general ophthalmology referrals to a single tertiary ophthalmology clinic. Retrospective cross-sectional study. Participants included Ophthalmology patients seen for their initial visit to a single tertiary ophthalmology clinic from July 2018 to December 2022. Ten randomly selected referrals from each day were screened for non-PFL as per the American Medical Association and American Psychological Association guidelines. Non-PFL was further categorized into general, diabetes, stigma, obesity, or ageism subcategories. The Chi-square test was used to evaluate associations between non-PFL use and referring provider gender and specialty, length of referral, and patient age and gender. A total of 2625 referrals were included in the study and 136 (5.2%) used non-PFL, such as referring to a person with diabetes as a "diabetic". Error types included Diabetes (38.2%), Stigma (30.9%), General (23.5%), Disability (8.8%), and Obesity (4.4%). Year of referral was predictive of non-PFL (P = .0016), with most occurring in 2020 (9.5%). Non-PFL was significantly more likely to occur in long length referrals compared to medium and short length referrals (16.2% vs. 5.1% vs. 3.5%, P < .001). Referring provider specialty was also predictive of non-PFL (P < .001) with most received by Family Medicine (8.3%), Optometry (4.4%), Emergency Medicine (0.62%), Ophthalmology (4.2%), Others (2.9%). Patient gender (P = .5563), patient age (P = .3466), and referring provider gender (P = .9057) were not predictive of non-PFL. Non-PFL use was most prevalent in 2020, with the most common referral sources being Family Medicine and Optometry. The highest proportions of non-PFL errors made were diabetes and stigma errors. Increased use of PFL in physician-physician communication can decrease intersectional stigma and promote inclusive patient care for ophthalmology patients.

Implementing teleophthalmology services to improve cost-effectiveness of the national eye care system

Background and purposeOptometrist-assisted and teleophthalmology-enabled referral pathway (OTRP) for community optometry referrals has the potential to improve the capacity and efficiency of eye care delivery systems through risk stratification and limiting the number of improved referrals. This study investigates the expected future costs and benefits of implementing OTRP under various possible organizational set-ups relevant to a Danish context.MethodsA decision-analytic model (decision tree) with a one-year time horizon was constructed to portray alternative future patient referral pathways for people examined in optometry stores for suspected ocular posterior segment eye disease. The main outcomes were total healthcare costs per patient, average waiting time from eye examination in store until the start of treatment or end of referral pathway, and quality-adjusted life-years (QALY) gained. The economic evaluation compares the general ophthalmologist referral pathway (GO-RP) with a potential reimbursement model for the optometrist-assisted teleophthalmology referral pathways (R-OTRP) and a procurement model for the optometrist-assisted teleophthalmology referral pathways (P-OTRP).ResultsThe cost per individual with suspected ocular posterior segment eye disease was estimated to be £116 for GO-RP and £75 and £94 for P-OTRP and R-OTRP respectively. The average waiting time for diagnosis or end of referral pathway was 25 weeks for GO-RP and 5.8 and 5.7 for P-OTPR and R-OTPR respectively. QALY gain was 0.15 for P-OTRP/R-OTRP compared to 0.06 for GO-RP.ConclusionOTRP is effective in reducing unnecessary referrals and waiting times, increasing patients’ HRQoL, and decreasing the costs of diagnosing individuals with suspected ocular posterior segment eye disease.

Diagnostic Strategy Using Color Doppler Ultrasound of Temporal Arteries in Patients With High Clinical Suspicion of Giant Cell Arteritis : A Prospective Cohort Study.

Giant cell arteritis (GCA) is the most prevalent systemic vasculitis in people older than 50 years. Any delay in diagnosis impairs patients' quality of life and can lead to permanent damage, particularly vision loss. To evaluate a diagnostic strategy for GCA using color Doppler ultrasound of the temporal artery as a first-line diagnostic test, temporal artery biopsy (TAB) as a secondary test, and physician expertise as the reference method. Prospective multicenter study with a 2-year follow-up. (ClinicalTrials.gov: NCT02703922). Patients were referred by their general practitioner or ophthalmologist to a physician with extensive experience in GCA diagnosis and management in one of the participating centers: 4 general and 2 university hospitals. 165 patients with high clinical suspicion of GCA, aged 79 years (IQR, 73 to 85 years). The diagnostic procedure was ultrasound, performed less than 7 days after initiation of corticosteroid therapy. Only ultrasound-negative patients underwent TAB. Bilateral temporal halo signs seen on ultrasound were considered positive. Ultrasound and TAB results were compared with physician-diagnosed GCA based on clinical findings and other imaging. Diagnosis of GCA was confirmed in 44%, 17%, and 21% of patients by ultrasound, TAB, and clinical expertise and/or other imaging tests, respectively. Their diagnosis remained unchanged at 1 month, and 2 years for those with available follow-up data. An alternative diagnosis was made in 18% of patients. The proportion of ultrasound-positive patients among patients with a clinical GCA diagnosis was 54% (95% CI, 45% to 62%). Small sample size, no blinding of ultrasound and TAB results, lack of an objective gold-standard comparator, and single diagnostic strategy. By using ultrasound of the temporal arteries as a first-line diagnostic tool in patients with high clinical suspicion of GCA, further diagnostic tests for patients with positive ultrasound were avoided. Tender "Recherche CH-CHU Poitou-Charentes 2014."

A Proposal of a New Tool for the Assessment of Damage in Behçet Syndrome Uveitis: Cerrahpasa Ocular Damage Grading System

ABSTRACT Introduction/Objective There is currently no tool available to assess the severity of damage in uveitis due to Behçet’s syndrome (BS). In this preliminary study, we developed a new grading system to evaluate ocular damage and assessed it in a prospective cohort. Methods A specialist in BS uveitis (YO) developed a grading system for ocular damage with five grades based on the extent of damage in the posterior segment. YO trained a senior and general ophthalmologist with sample fundus images. BS patients who had undergone color fundus photography during their routine visits in attack-free periods were included in the study. The color fundus photos of this prospective cohort were evaluated blindly by YO and his trainees using the new grading tool. Inter and intra-observer agreement between the graders were assessed by Cohen’s kappa analysis. The evaluation of YO was considered as the gold standard. Results One hundred eighty-five eyes of 108 (29 F/79 M) patients with BS uveitis were graded for damage by two investigators. Their mean age was 38,58 years and their median ocular disease duration was 13 years. The gold standard and the two investigators exhibited substantial concordance with the ocular damage grading system. The inter- and intra-observer agreement were also almost perfect. Conclusion The newly developed ocular damage grading system enables the standardization of damage severity in BS uveitis. It is imperative to conduct internal and external validations across diverse cohorts. Furthermore, future studies should investigate its correlation with other multimodal imaging methods such as fluorescein angiography and optical coherence tomography.

A Preliminary Evaluation of the Diagnostic Performance of a Smartphone-Based Machine Learning-Assisted System for Evaluation of Clinical Activity Score in Digital Images of Thyroid-Associated Orbitopathy.

Background: We previously developed a machine learning (ML)-assisted system for predicting the clinical activity score (CAS) in thyroid-associated orbitopathy (TAO) using digital facial images taken by a digital single-lens reflex camera in a studio setting. In this study, we aimed to apply this system to smartphones and detect active TAO (CAS ≥3) using facial images captured by smartphone cameras. We evaluated the performance of our system on various smartphone models and compared it with the performance of ophthalmologists with varying clinical experience. Methods: We applied the preexisting ML architecture to classify photos taken with smartphones (Galaxy S21 Ultra, iPhone 12 pro, iPhone 11, iPhone SE 2020, Galaxy M20, and Galaxy A21S). The performance was evaluated with smartphone-captured images from 100 patients with TAO. Three ophthalmology residents, three general ophthalmologists with <5 years of clinical experience, and three oculoplastic specialists independently interpreted the same set of images taken under a studio environment and compared their results with those generated by the smartphone-based ML-assisted system. Reference CAS was determined by a consensus of three oculoplastic specialists. Results: Active TAO (CAS ≥3) was identified in 28 patients. Smartphone model used in capturing facial images influenced active TAO detection performance (F1 score 0.59-0.72). The smartphone-based system showed 74.5% sensitivity, 84.8% specificity, and F1 score 0.70 on top three smartphones. On images from all six smartphones, average sensitivity, specificity, and F1 score were 71.4%, 81.6%, and 0.66, respectively. Ophthalmology residents' values were 69.1%, 55.1%, and 0.46. General ophthalmologists' values were 61.9%, 79.6%, and 0.55. Oculoplastic specialists' values were 73.8%, 90.7%, and 0.75. This smartphone-based ML-assisted system predicted CAS within 1 point of reference CAS in 90.7% using facial images from smartphones. Conclusions: Our smartphone-based ML-assisted system shows reasonable accuracy in detecting active TAO, comparable with oculoplastic specialists and outperforming residents and general ophthalmologists. It may enable reliable self-monitoring for disease activity, but confirmatory research is needed for clinical application.

E043 Fast track giant cell arteritis service in a district general hospital using ultrasound doppler imaging

Abstract Background/Aims Giant cell arteritis (GCA) is the commonest large and medium artery vasculitis, a multisystem condition that results in significant comorbidity and mortality. Corticosteroids are pivotal in remission induction and maintenance therapy, but complications can arise either due to delayed treatment, or unnecessary treatment of GCA mimics. This renders quick diagnosis of GCA vital. Temporal artery biopsy (TAB) has traditionally been the golden standard diagnostic modality, but it requires a surgical setting, resulting in delays. Temporal artery ultrasound doppler scanning (TA UDS), however, has now been incorporated by both BSR and EULAR in their recommendations, offering a diagnostic tool with high specificity and sensitivity. Aims 1. To set up a fast track GCA diagnostic service in an one-stop-shop outpatient clinical setting with inhouse ultrasound; 2. To limit dependence of GCA diagnosis on TAB Methods We set up a dedicated GCA clinic at Eastbourne District General Hospital aiming to see patients within five days of referral. In the clinic, patients were categorised to low, moderate or high GCA risk via a pre-test probability score, and had TA UDS by an expert rheumatologist. We collected data on number of UDS performed, scan outcomes, and TAB requests over a 17-month period. Results Total number of referrals with suspected GCA was 147, mainly via general practice and ophthalmology, with 117 already having been started on corticosteroids by the referrer. Overall, 93% of patients were seen within five days of initial referral, with 32% within 72 hours of steroid commencement. We scanned 138 patients (94%) and diagnosed GCA in 41 (30%) of them. Of the nine we did not scan, six had very low probability score and were given alternative diagnoses; two were out of the window for diagnostics and GCA was diagnosed clinically; and one could not be scanned due to technical reasons, so a TAB was requested. Crucially, this was the only TAB requested during this period. Conclusion Our fast track service has facilitated prompt review of GCA referrals with the use of ultrasound, limiting the need for a TAB. The pathway enables both prompt commencement of appropriate steroid-weaning regimens in confirmed GCA, but also facilitates timely discontinuation of corticosteroids in patients with excluded GCA, thus minimising future complications either way. Typically, it takes more than three weeks to arrange a TAB. Moreover, ultrasound use avoids an invasive procedure with potential for surgical complications. From a healthcare system point of view, there are certain cost-saving implications in using ultrasound for GCA diagnosis. These can range from reduced demand for outpatient clinics, theatre slots and theatre staff, to minimisation of any future complications be it post-op, disease- or steroid- related. Finally, a service user survey, aiming to improve our pathway, documented improved patient satisfaction. Disclosure P. Kamperidis: None. A. Hall: None. H. Perera: None. S. Panthakalam: None.

IJCM_277A: Awareness, Perception and Attitude of Medical Interns and Graduates Towards Robotic Surgery: A Cross-Sectional Study

Background: Robotic surgery is a novel venture in medical sciences that uses robotic systems to assist and carry out surgical procedures and is one of the most discussed topics in surgery today. However, there is paucity of information regarding awareness, attitude and perceptions related to robotic surgery among the future surgical care providers (i.e., interns and postgraduates). Methodology: This cross-sectional study was carried out among all the Medical Interns and the Postgraduates posted in the surgical Departments of KMC Mangalore (General Surgery, OBG, ENT, Ophthalmology, Orthopedics and Anaesthesia) using Universal sampling technique and data were collected using a semi-structured, pre-validated questionnaire consisting of two sections. The collected data were analyzed using SPSS software version 25. The results were summarized as percentages, tables and figures. For comparison across the groups chi-square test was used and a value less than 0.05 was considered statistically significant. Results: One hundred sixty-nine Interns and surgical Postgraduates were included in total in the study with a mean age of 25 years. Among the study participants,57.3% (n=59) of Interns and 57.6% (n=38) of Postgraduates have seen robotic surgery being performed in the past. More than half of the study participants, 66%(n=68) interns and 72.7%(n=48) postgraduates were aware of the Da Vinci robotic surgical system. Among the challenges for mainstreaming robotic surgery, cost was the most important concern among 53.3% (n=57) interns and 53%(n=35) postgraduates. Conclusion: In our study majority of the participants, Interns (64.1%) and Post graduates (84.8%) had a positive outlook towards robotic surgery &amp; believed cost (55.3 % Interns and 53% Post graduates) was one of the major constrains limiting its use

Ophthalmic care may not align with patient need: An analysis on state-wide patient needs and provider density between 2008 and 2022

PurposeThis study aims to assess the extent to which the demand for ophthalmologic care among patients at the state level is reflected in Google Trends data, serving as an indicator of patient desire in ophthalmology. MethodsFor each state, patient interest in ophthalmologic care was estimated using the Google Trends resource measuring web search and YouTube search rates for multiple ophthalmologic terms. We compared the change in search for ophthalmologic terms over time and used ordinary least squares regression to evaluate whether search interest for ophthalmologic terms was able to predict the rate of practicing ophthalmologists in each state. We also compare the changing rates of searches across the web and YouTube to evaluate the resources patients are most likely to utilize. ResultsFrom 2008 to 2022, web search rates for general ophthalmology related terms increased by 43.98%, while search interest for retinal specific terms increased by 19.51%. YouTube specific results for general ophthalmology terms increased by 55.83% while search for retinal terms fell by 58.48%. Ophthalmologic and retinal specific search interest was not significantly associated with either outcome. ConclusionsOur findings suggest that patient information needs, demographic elements, and the educational backgrounds of residents and fellows – those important factors – are surprisingly poorly correlated with ophthalmology provider density. Furthermore, we observed no noteworthy correlation between the search interest in ophthalmology and the overall density of ophthalmologists or retinal specialists. This implies that there is a pressing need to explore and implement strategies aimed at better aligning these influencing factors the choices made by ophthalmologists in selecting their practice locations to bridge the gap between healthcare availability and public interest.

A Framework for Future Analysis of Ophthalmology Fellowships in Iran: Call for Action, Implications and Recommendations.

Ophthalmology fellowship is focusing on the educational advancement, medical research progress and academic productivity by transforming general ophthalmologists into superior clinical capacities in ophthalmology. There is a vast majority of ophthalmologists who wish to undertake fellowship degrees. The fellowship programs have several benefits for ophthalmologists and medical institutions. However, the expansion of ophthalmic fellowships has resulted in a greater number of ophthalmology visits, the possibility of unnecessary subspecialty eye examinations, induced demand and increasing eye-care costs. Moreover, sub-specialized ophthalmic services are not accessible to patients in remote regions. This can lead to a degree of inequity in the provision of healthcare services in the healthcare system. The massive expansion of fellowships in ophthalmology is revitalizing the necessity for evaluation of the need for post-residency education and providing effective planning for the future of the ophthalmic human-resource for eye health. This narrative review includes an integration and descriptive summary of the existing evidence on trends and different aspects that affect the future of ophthalmic fellowship education. Moreover, we pinpointed challenges such as maintaining standards in fellowship education, keeping an efficient production of graduates, and improving productivity in both patient care and education. We explored potential solutions to overcome these challenges. The 7-step framework for future analysis suggested here includes Determining educational needs and desired outcomes, Evaluating the current status of fellowship education, determining the gaps, and appropriate solutions, analyzing possible future trends and their impact on ophthalmology practice, investing in virtual educational technology, developing new educational horizons by foresight expert panels, and human-resource planning.

Corneal blindness in the developing world: The role of prevention strategies.

Corneal blindness is an important contributor to the burden of global blindness and has a greater prevalence in low-income countries of the developing world where resources and infrastructure are limited. The causes of corneal blindness too are different from high-income countries and include infectious keratitis, ocular trauma, and xerophthalmia. Persons with these indications tend to have unfavourable outcomes after corneal transplantation, limiting their chances of benefitting from this sight-saving procedure. However, most causes of corneal blindness in the developing world are preventable. This highlights the importance of understanding the unique challenges in these regions and the need for targeted interventions. This article discusses various prevention strategies, including primordial, primary, and secondary prevention, aimed at reducing the burden of corneal blindness in low-income countries. These include capacity building, training, and awareness campaigns to reduce the risk factors of ocular trauma, infectious keratitis, and to improve access to first aid. It is also important to promote safe eye practices and tackle nutritional deficiencies through public health interventions and policy changes. Providing the required training to general ophthalmologists in the management of basic corneal surgeries and diseases and enhancing the accessibility of eye care services in rural areas will ensure early treatment and prevent sequelae. Current treatment modalities belong to the tertiary level of prevention and are largely limited to corneal transplantation. In developing nations, there is a scarcity of donor corneal tissue necessitating an urgent expansion of eye banking services. Alternative approaches to corneal transplantation such as 3D printed corneas, cultured stem cells, and biomaterials should also be explored to meet this demand. Thus, there is a need for collaborative efforts between healthcare professionals, policymakers, and communities to implement effective prevention strategies and reduce the prevalence of corneal blindness in the developing world.