General Ophthalmology Research Articles

Telemedicine for the Diagnosis and Management of Age-Related Macular Degeneration: A Review.

Use of ophthalmic telemedicine for patients with age-related macular degeneration (AMD) has shown remarkable advances over recent years. The recent COVID pandemic accelerated this transition since in-person evaluation of elderly patients at high risk for advanced AMD and severe vision loss were also at higher risk for complications from COVID infection. To date, ophthalmic telemedicine has been successfully used in remote retinal consultation by general ophthalmologists for AMD management, hybrid testing visits with both in-office testing and remote evaluation, as well as early successes in home-based remote monitoring of patients with high-risk AMD. We therefore review the current literature and evidence base related to ophthalmic telemedicine for AMD.

Can Routine Patients Be Safely Discharged After Neodymium-Doped Yttrium Aluminium Garnet Laser Posterior Capsulotomy?

BackgroundNeodymium-doped yttrium aluminium garnet (Nd:YAG) posterior capsulotomy is a common treatment for posterior capsular opacification. Practice varies regarding routine follow-up. In this study, we reviewed follow-up rates and treatment-related complications from a district general hospital’s ophthalmology unit to assess areas for improvement and cost-effectiveness.MethodologyWe conducted a retrospective review of electronic patient records for all patients treated with Nd:YAG capsulotomy in 2019 at our hospital. Primary outcomes included visual acuity, complications, and follow-up data. Secondary outcomes included medication prescribing and the grade of surgeon.ResultsIn total, 912 eyes of 744 patients were included. Overall, 536 (58.8%) eyes were discharged immediately following their laser. Complication rate was 4.3% (39 eyes). Junior training grades had a higher rate of medication prescribing (40/46 eyes; 87.0%) and follow-up (36/40 eyes; 78.3%).ConclusionsCertain selected patients may be safely discharged following capsulotomy with safety-netting advice. This strategy increases the capacity to follow-up patients at higher risk of complications. Higher rates of follow-up among junior ophthalmologists offers potential for training.

Deep Learning Prediction of Response to Anti-VEGF among Diabetic Macular Edema Patients: Treatment Response Analyzer System (TRAS).

Diabetic macular edema (DME) is the most common cause of visual impairment among patients with diabetes mellitus. Anti-vascular endothelial growth factors (Anti-VEGFs) are considered the first line in its management. The aim of this research has been to develop a deep learning (DL) model for predicting response to intravitreal anti-VEGF injections among DME patients. The research included treatment naive DME patients who were treated with anti-VEGF. Patient’s pre-treatment and post-treatment clinical and macular optical coherence tomography (OCT) were assessed by retina specialists, who annotated pre-treatment images for five prognostic features. Patients were also classified based on their response to treatment in their post-treatment OCT into either good responder, defined as a reduction of thickness by >25% or 50 µm by 3 months, or poor responder. A novel modified U-net DL model for image segmentation, and another DL EfficientNet-B3 model for response classification were developed and implemented for predicting response to anti-VEGF injections among patients with DME. Finally, the classification DL model was compared with different levels of ophthalmology residents and specialists regarding response classification accuracy. The segmentation deep learning model resulted in segmentation accuracy of 95.9%, with a specificity of 98.9%, and a sensitivity of 87.9%. The classification accuracy of classifying patients’ images into good and poor responders reached 75%. Upon comparing the model’s performance with practicing ophthalmology residents, ophthalmologists and retina specialists, the model’s accuracy is comparable to ophthalmologist’s accuracy. The developed DL models can segment and predict response to anti-VEGF treatment among DME patients with comparable accuracy to general ophthalmologists. Further training on a larger dataset is nonetheless needed to yield more accurate response predictions.

Telephone and Video Consultations within Qatar's Primary Health Care Corporation

Background: The COVID-19 pandemic changed the way we deliver primary health care services for good. The need to protect staff and patients from the spread of infection while still providing essential healthcare services to the public was challenging but ignited innovations to facilitate healthcare delivery. International research supports the action of containing the spread of a virus by limiting the number of people co-located, if possible1. The implementation of telephone and video consultations started in March 2020 in Qatar, within 4 weeks of COVID-19 being detected in the community, to support patient safety and provide primary health care services. Methods: Qatar's Primary Health Care Corporation (PHCC) implemented telephone consultations at 27 health care centers across general and specialty services to meet patients’ demands. Video consultations swiftly followed within an inbound community call center and 10 health care centers for general medicine, dental, and ophthalmology services. The latter then expanded to include, dermatology, and physiotherapy services. Results: Patients quickly adapted to attending telephone consultations as they understood the safety aspects of staying home unless a face-to-face consultation was absolutely necessary. The implementation of telephone and video consultations within PHCC has been successful as over 1,000,000 telephone consultations and more than 2,000 video consultations have been completed in one year. At the climax of the pandemic (around June 2020) approximately 50% of consultations were held virtually (Table 1: Telephone consultations versus in-person visits from April to July 2020). Conclusion: The implementation of telephone and video consultation services within PHCC, imposed by the pandemic, changed the way to connect and deliver services to patients. As the pandemic continues, this offers an alternative to face-to-face visits and is widely accepted by the public as a model of care delivery. The use of telephone and video consultations are widely implemented across the globe and both patients and clinicians have adapted well to such new ways of working2,3.

Efficacy, feasibility, and patient acceptance of using low-dose atropine in retarding myopia progression: A general ophthalmologist's perspective

Efficacy, feasibility, and patient acceptance of using low-dose atropine in retarding myopia progression: A general ophthalmologist's perspective

A Qualitative Study on Continuing Medical Education Programs for Practicing Ophthalmologists in Iran:Changing Previous Norms.

Introduction: The Continuing Medical Education (CME) programs in the medical community aim to improve the knowledge of practitioners and its effect on changing their performance. Previous studies showed that CME causes minimum changes in physicians’ behaviors, so it is important to pay attention to the views of this group. In this regard, this qualitative study aimed to explain the Iranian Ophthalmologists’ perceptions and experiences concerning the CME Programs in Iran. Methods: In this qualitative study, 18 participants, including 10 subspecialists and 8 general ophthalmologists, were recruited to participate in in-depth interviews concerning their experiences with CME. The required data were collected from April 2018 to Feb 2019. Each interview was conducted in medical universities; eye research centers; and the ophthalmology departments, offices, and operating rooms of public and private hospitals. The current study was performed using a content analysis based on the Granheim and Lundman’s methods. The codes, sub- categories, categories, and themes were then explored through an inductive process in which the researchers moved from specific to general. Result: The data obtained from interviews, and filed notes were analyzed and then classified into the following four themes: "growth and development of the ophthalmology's CME program over time", "challenges of the ophthalmology's CME program", "reasons for the participation of the ophthalmologist in the CME program", and "strategies for improvement". Conclusion: Based on the qualitative study’s results, in spite of growth and development of the design and implementation of the Ophthalmologic CME programs, we are still facing multiple challenges. Enhancing the interactivity between the providers and participants can also improve the ophthalmology CME programs.

Pattern of uveitis in general Ophthalmology practice

Aim: The aim of this study is to describe the pattern of uveitis in a General Ophthalmology Clinic in North Karnataka. Materials and Methods: Case records of uveitis seen from June 2015 to December 2019 were reviewed retrospectively. Data regarding the patients' age, sex, anatomical location of the disease, and etiology were analyzed. Results: A total of 119 records were reviewed. The mean age at the presentation was 40.4 years with a male preponderance. The majority of unilateral cases had anterior uveitis. We could establish a specific diagnosis in 63.9% of cases. The most common noninfectious etiology was spondyloarthropathy causing anterior uveitis (19.3%) and tuberculosis causing posterior uveitis is the most common form of infective etiology (12.9%). Conclusion: Our study revealed that anterior uveitis of noninfectious etiology is more frequently encountered by general/comprehensive ophthalmologists. In our region, the most common cause of anterior uveitis was spondyloarthropathy, whereas infectious etiology must be considered in posterior uveitis, and the most common etiology in our region was tuberculosis.

Glaucoma suspects referred by general ophthalmologists to a tertiary center in Brazil: outcomes of the glaucoma specialist assessment.

To characterize patients with suspected glaucoma who were referred to the clinic for suspected glaucoma in a tertiary public hospital in southern Brazil and to evaluate differences in functional and structural damages between patients diagnosed with different types of glaucoma, those with normal eye examination results, and those who remained as glaucoma suspects. This is a cohort study of patients referred by general ophthalmologists to the clinic for suspected glaucoma at Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, between March 2016 and December 2018. The patients were followed up until they had undergone reliable examinations (eye examination, visual field screening, and optic coherence tomography for classification as normal and having a suspected glaucoma, glaucoma with an elevated intraocular pressure, normotensive glaucoma, or ocular hypertension. A total of 135 patients were included in this study. Of the patients, 117 subjects completed all examinations and met the inclusion criteria. Most patients were normal (36.8%), followed by those with suspected glaucoma (25.64%), normal tension glaucoma (18.8%), glaucoma with elevated intraocular pressure (12%), and ocular hypertensive (6%). The main reason for referral was increased optic nerve head cupping. The patients with normal tension glaucoma were older than the other subjects on average (p=0.03). In addition, the normal tension glaucoma group had a significantly worse baseline visual field index and mean deviation of the visual field than the normal, glaucoma suspect, and ocular hypertensive groups. The circumpapillary retinal nerve fiber layer on OCT was thinner on average in the normal tension glaucoma group than in the normal and glaucoma suspect groups (p<0.002) but did not significantly differ between the glaucoma group with elevated intraocular pressure and the other groups. Patients with normal tension glaucoma tend to be diagnosed later because of their normal intraocular pressures; thus, the optic nerve cupping must be greater to raise the suspicion of glaucoma. In this study, we found that the patients with normal tension glaucoma had worse disease at the time of diagnosis.

Treatment of noninfectious uveitis.

Uveitis is a broad term that refers to a large group of eye disorders categorized by intraocular inflammation, a leading cause of visual impairment. Historically, treatment of noninfectious uveitis has depended on corticosteroid drugs. Owing to the myriad of side effects caused by corticosteroids, immunomodulatory therapy has become the preferred treatment for chronic noninfectious intraocular inflammation. Recently, biological response modifiers have established a new era in uveitis therapy, with the range of targets continuing to expand. In this review, we aimed to convey up-to-date information on the treatment of noninfectious uveitis to the general ophthalmologist.

Vision “wipe-out” phenomena following a nonincisional laser procedure in the management of narrow-angle glaucoma

The “Wipe-out” or “Snuff-out” phenomenon refers to a permanent and severe loss of vision without an identifiable cause and is considered a rare but dreaded consequence of incisional ocular surgery. It is believed to occur in patients with advanced glaucoma who demonstrate a residual central island of vision. A 42-year-old female patient presented to the general ophthalmology clinic with complaints of painless blurring of vision of the left eye for 8 months. Best-corrected visual acuity (BCVA) was 20/30 and 20/40 and intraocular pressure (IOP) was 26 mmHg and 28 mmHg in the right and left eyes, respectively. Relative afferent pupillary defect was noted in the left eye. Anterior segment examination showed peripherally shallow anterior chamber and gonioscopy revealed appositionally closed angles (Shaffer-<20 Deg) in both eyes. Fundus examination showed advanced glaucomatous optic neuropathy of the left eye. Generalized depression in the right eye and inferior arcuate scotoma with a superior nasal step, and split fixation in the left eye was seen on Humphreys 30-2 visual fields. A diagnosis of chronic primary angle closure glaucoma was made and the patient was offered Nd: Yag Laser Peripheral Iridotomy (LPI). LPI was completed for the right eye and Argon Laser Iridoplasty was performed in the left eye as Iridotomy was not possible due to the proximity of the iris to the cornea as the pupil was mid-dilated. After the procedure, the patient was prescribed topical antiglaucoma medications with topical steroids at 1 week follow-up, the patient had BCVA of 20/30 in the right eye and hand motion in the left eye, IOPs were well controlled on topical anti-glaucoma medication. A thorough examination including a dilated fundus examination, B-Scan ultrasound, and fundus fluorescein angiography were unremarkable. Magnetic resonance imaging scan of the brain and orbits was normal. “Wipeout” phenomenon is a rare but notorious complication associated with incisional surgeries in patients with advanced glaucoma. It is also reported to occur following cataract and retinal incisional surgeries. There are no reports of a wipe-out after a commonly performed laser procedure.

OCULAR CLINICAL PROFILE OF PATIENTS WITH PSEUDOEXFOLIATION SYNDROME AND PSEUDOEXFOLIATION GLAUCOMA AT TERTIARY CARE CENTRE IN KASHMIR

Aim: To study the clinical profile of pseudoexfoliation (PEX) syndrome and Pseudoexfoliation glaucoma at tertiary care centre in Kashmir. Materials and Methods: A cross sectional study consisting of 100 PEX and 100 PEXG patiens, attending the general ophthalmology clinic of a tertiary care center in kashmir. All patients underwent a complete ophthalmologic evaluation including recording IOP,gonioscopy and Central Corneal Thickness(CCT). Results: The study cohort comprised 200 patients(100 with PEX and 100 with PEXG). There were 145(72.5) males and 55(27.5%) females. The highest number of patients (120 patients) were from the age group between 61 and 70years. 145(72.5%) patients were involved in outdoor activities.153(76.5%) patients had bilateral involvement of pseudoexfoliationand pseudoexfoliative material was present at anterior lens capsule in 175(49.58%) eyes. Nuclear cataract was predominant type of cataract and was present in 188(48.2%)eyes. Mean IOP was 17.26±7.634mmHg in PEX group and 24.39±4.456mmHg in PEXG group. Gonioscopyshowed open angles in 96.5% of eyes and occludable in 3.5% eyes . Mean central corneal thickness was 531.80±19.127μm. Conclusion: The prevalence of PEX is found to increase with age. Patients with PXG had more severity of optic nerve damage at presentation. Therefore a careful assessment for detection of PEX is warranted and regular follow-up of patients is desired to minimize the extent of optic nerve damage.

A Clinical Case of Two-Stage Visual-Functional Rehabilitation of a Patient with Postinfectious Central Corneal Opacity in Combination with Mixed Astigmatism Using Laser Keratorefractive Surgery

Introduction: to evaluate the clinical and functional results of two-stage treatment in a patient with post-infectious Central corneal opacity combined with mixed astigmatism.Patient and methods. Patient N., 19 years old with postinfectious (postherpetic) Central corneal opacity, mixed astigmatism was examined and operated using two-stage corneal laser treatment. To determine the possibility of surgical treatment of the patient, a complex of General ophthalmology was performed (checking visual acuity near and far in natural conditions and in conditions of drug-induced mydriasis, IOP measurement, autorefractometry, examination of visual fields, A- and Bscanning, ophthalmoscopy with examination of the Central and peripheral areas of the fundus), as well as special (keratopography and Scheimpflug camera examination, optical coherence tomography (OCT) of the anterior segment of the eye with analysis of the epithelial map, quantitative assessment (Schirmer test-1) and qualitative (tear film rupture time) lachrymal products, assessment of the epithelium state when stained with vital dyes and infrared meibography) research methods. To determine the activity of herpetic infection, PCR diagnostics were performed. The follow-up period was 2 years.Results and discussion. To achieve high visual-functional rehabilitation while preserving the native lens, a two-stage treatment algorithm was developed using technologies of laser corneal refractive surgery. At the first stage, in order to regularize the ocular surface and eliminate Central corneal opacity, an inverted topographically oriented PRK was performed; at the second stage, residual refractive errors were corrected using topographically oriented FemtoLASIK technology.Conclusion. According to the results of a literature search and analysis of Internet resources, there were no previously recorded and published works using a similar two-stage method. Therefore, the described clinical case justifies the relevance and novelty of the goal and has an evidence-based Foundation for the use of a two-stage laser keratorefractive treatment system in the ophthalmological practice of visual and functional rehabilitation of patients with Central corneal opacity in combination with mixed astigmatism or hypermetropic refraction. The two-year postoperative follow-up period showed stable and high visual-functional results with no recurrence of the inflammatory process.

Trends in Surgical Case Volume During Pacific Partnership Missions Onboard USNS Mercy.

Since 2006, the U.S. Navy has conducted six Pacific Partnership (PP) missions throughout Southeast Asia on board the U.S. Naval Ship Mercy (T-AH 19). This study describes trends in overall and surgical specialty operative volumes to better understand the burden of surgical disease treated during these humanitarian and civic assistance (HCA) operations. This information can assist medical planners and surgical leaders involved in future humanitarian missions. Following approval from the Naval Medical Center San Diego Institutional Review Board, a retrospective review of surgical case data was performed for the six PP missions from 2006 to 2018. Data collected included patient demographics, Current Procedural Terminology codes, and surgical specialty. The primary outcome was surgical case volume per specialty. Secondary outcomes included surgical staffing per mission and overall trends in operative volume. A total of 3,826 operative procedures were performed during the study period. Mission years in which case volume for both general surgery and ophthalmology were below their respective medians were associated with the least total surgical services to host nations (HNs). The number of active duty Navy surgeons varied with each mission; however, the staffing for a PP mission generally included at least two general surgeons, one ophthalmologist, one plastic surgeon, one pediatric surgeon, one orthopedic surgeon, one otolaryngologist, one oral surgeon, one urologist, and one obstetrician-gynecologist. Case volume per surgeon was highest in 2006 (50 cases per surgeon) and decreased after 2006, reaching an all-time low during the 2018 PP mission (10 cases per surgeon). Pediatric surgery and plastic surgery had the highest average case volumes per surgeon at 58 and 46 cases per surgeon, respectively, while oromaxillofacial surgery and neurosurgery had the lowest average case volumes per surgeon at 9 and 14 cases per surgeon, respectively. Operative volume on military HCA missions is greatly influenced by the priorities of the HN, the mission focus, the number of individuals from the HN that present for screening, and the availability of personnel and resources available on the hospital ship. Future mission planning should optimize general surgery and ophthalmology staffing and essential equipment, as total mission case volumes were highly dependent upon the productivity of these two specialties. Careful determination of the surgical needs of HNs should serve as a guide for the selection of subspecialists to maximize effectiveness in future military HCA missions.

Bridging the Gap between Ophthalmology and Emergency Medicine in Community-Based Emergency Departments (EDs): A Neuro-Ophthalmology Guide for ED Practitioners.

Coordination of care for patients with neuro-ophthalmic disorders can be very challenging in the community emergency department (ED) setting. Unlike university- or tertiary hospital-based EDs, the general ophthalmologist is often not as familiar with neuro-ophthalmology and the examination of neuro-ophthalmology patients in the acute ED setting. Embracing image capturing of the fundus, using a non-mydriatic camera, may be a game-changer for communication between ED physicians, ophthalmologists, and tele-neurologists. Patient care decisions can now be made with photographic documentation that is then conveyed through HIPAA-compliant messaging with accurate and useful information with both ease and convenience. Likewise, external photos of the anterior segment and motility are also helpful. Finally, establishing clinical and imaging guidelines for common neuro-ophthalmic disorders can help facilitate complete and appropriate evaluation and treatment.

The current status of the diversity pipeline in surgical training

ObjectiveRecent initiatives have emphasized the importance of diversity, equity, and inclusion in academic surgery. Racial/ethnic disparities remain prevalent throughout surgical training, and the “diversity pipeline” in resident recruitment and retention remains poorly defined. MethodsData was retrospectively collected using two separate datasets. The Association of American Medical Colleges database was used to obtain demographic data on US medical school graduates. The US Graduate Medical Education annual report was used to obtain demographic data on surgical residents. Wilcoxon signed-rank test was used to compare racial/ethnic distribution within surgical residency programs with graduating medical students. Linear regression analysis was performed to analyze population trends over time. ResultsThe study population included 184,690 surgical residents from 2011 to 2020. Nine resident cohorts were created according to surgical specialty – general surgery, neurosurgery, ophthalmology, orthopedic surgery, otolaryngology, plastic surgery, cardiothoracic surgery, urology, and vascular surgery. Among surgical programs, White residents were overrepresented in 8 of 9 specialties compared to the concurrent graduating medical student class for all years (p < 0.01 each, no difference in ophthalmology). Black residents were underrepresented in 8 of 9 specialties (p < 0.01 each, no difference in general surgery). Asian representation was mixed among specialties (4 overrepresented, 1 equal, 4 underrepresented), as was Hispanic representation (5 overrepresented, 4 equal) (p < 0.01 each). ConclusionsThese data suggest that racial/ethnic disparities are inherent to the process of recruitment and retention of surgical residents. Efforts to improve the “diversity pipeline” should focus on mentorship and development of minority medical students and creating an equitable learning environment.

Assessment and Management of Dry Eye Disease and Meibomian Gland Dysfunction: Providing a Singapore Framework.

The purpose of this article is to provide a framework for general ophthalmologists in Singapore to manage dry eye. This framework considers the evidence in the literature as well as recommendations from expert panels such as the Tear Film & Ocular Surface Society Dry Eye Workshop II and the Asia Cornea Society Workgroup.This article covers the assessment of patient medical history and ask triage questions to identify local and systemic causes of dry eye disease (DED), excluding other possible causes, as well as the risk factors for DED and ocular surface inflammation. Evaluation of clinical signs to establish the diagnosis of DED and differentiation from other causes of irritable, red eyes are described. Tests for understanding the underlying disease processes and severity of DED are also presented.Management of dry eye should involve patient education and engagement. Information about the natural history and chronic nature of DED should be provided to improve long-term management of the disease and enhance compliance. Aggravating factors should be removed or lessened.We provide a guide to determine the most appropriate treatment (or combination of treatments) based on the severity and cause(s) of the disease, as well as the patient's needs and preferences. The aim of the management is to relieve ocular discomfort and prevent worsening of symptoms and signs, as well as to optimize visual function and minimize structural ocular damage. We also discuss the systematic follow-up and assessment of treatment response, as well as monitoring side effects of treatment, bearing in mind continuous support and reassurance to patients.

Development of deep learning-based detecting systems for pathologic myopia using retinal fundus images

Globally, cases of myopia have reached epidemic levels. High myopia and pathological myopia (PM) are the leading cause of visual impairment and blindness in China, demanding a large volume of myopia screening tasks to control the rapid growing myopic prevalence. It is desirable to develop the automatically intelligent system to facilitate these time- and labor- consuming tasks. In this study, we designed a series of deep learning systems to detect PM and myopic macular lesions according to a recent international photographic classification system (META-PM) classification based on color fundus images. Notably, our systems recorded robust performance both in the test and external validation dataset. The performance was comparable to the general ophthalmologist and retinal specialist. With the extensive adoption of this technology, effective mass screening for myopic population will become feasible on a national scale.

Interobserver and Intra-Observer Reliability of Eyelid Tests for Ocular Myasthenia Gravis.

Lid fatigability test (LFT), Cogan lid twitch (CLT), and forced eyelids closure test (FECT) are simple clinical screening tests for ocular myasthenia gravis (OMG). However, these tests are subjectively interpreted. We thus evaluated the interobserver and intra-observer reliability of each test. The 3 eyelid tests were performed in ptotic patients associated with various conditions, including OMG and others. Video clips of all tests were recorded using smartphone with built-in camera in the following order; LFT, CLT, and FECT. All video clips were distributed to 3 neuro-ophthalmologists and 3 general ophthalmologists, who were trained to evaluate the tests using a single standard instruction. After 3 months, all video clips were re-organized for the second evaluation. Interobserver and intra-observer reliability were calculated using Cohens' Kappa coefficient and Fleiss Kappa statistic. The 3 eyelid tests were performed and recorded in 35 patients, which included the diagnosis of OMG, levator muscle dehiscence, partial oculomotor nerve palsy, and Horner syndrome. CLT received moderate-to-substantial interobserver reliability in neuro-ophthalmologist group (Fleiss Kappa 0.77 [95% CI 0.60-0.94] and 0.66 [95% CI 0.46-0.85] in first and second evaluation respectively), but the results varied in general ophthalmologist group (Fleiss Kappa 0.58 [95% CI 0.37-0.79] and 0.54 [95% CI 0.33-0.76] in first and second evaluation respectively). FECT and LFT received lower interobserver reliability in both groups. CLT also received moderate-to-almost perfect intra-observer reliability in neuro-ophthalmologist group (Cohen Kappa 0.55, 0.58, and 0.92), whereas FECT and LFT received lower intra-observer reliability. The intra-observer reliability varied among general ophthalmologists for all 3 eyelid tests. CLT is the most reliable test among the 3 eyelid tests. However, all tests should be interpreted with caution by general ophthalmologists.

Incidence of Referable Retinal Disease in Diabetic Patients at a Primary Care Practice.

This work tests the feasibility of remote ophthalmic imaging to identify referable retinal abnormalities and assesses the effectiveness of color fundus photography (CFP) vs optical coherence tomography (OCT) for this purpose. This prospective, nonrandomized study included 633 patients with diabetes at Duke Primary Care. Undilated patients underwent screening with CFP and OCT camera (MaestroCare, Topcon). Images were graded independently for interpretability and the presence of predetermined retinal disease. Retinal disease was classified as diabetic retinopathy (DR) referable to a retina specialist or incidental findings referable to either a retina specialist or a general ophthalmologist, depending on severity. Mean (SD) age of screened patients was 66 (13) years, and 49% were women. The average glycated hemoglobin A1c level was 7.6 % (SD, 1.7%), and 30% of the patients were on insulin. The average duration of diabetes was 5.9 (SD, 7.3) years. Remote images from OCT were significantly more interpretable than CFP (98% vs 83%, respectively; P < .001). Referral rates were 9% for DR and 28% for incidental findings. Among patients with DR, OCT and CFP were helpful in 58% and 87% of cases, respectively (P < .001). Remote diagnosis of ophthalmic imaging at the point of service may allow for early identification of retinal disease and timely referral and treatment. Our approach showed that OCT had significantly better interpretability, while CFP was more helpful in identifying DR. These findings may be important when choosing the screening device in a specific context.

Ease and Willingness to Use Smartphone Applications for Visual Acuity Assessment Among Patients in Ahmadu Bello University Teaching Hospital, Zaria.

Background:Smartphone applications (apps) are increasingly becoming more popular for medical use.Aim:The aim of this article is to determine the willingness and ease of using smartphone apps for visual assessment among adult patients attending the general outpatient ophthalmology clinic of Ahmadu Bello University Teaching Hospital, Zaria in Nigeria.Design:The study was a hospital-based descriptive cross-sectional design.Materials and Methods:New and old adult patients who presented at the clinic and consented to the study were selected. Visual acuity assessment was done using a 6-m Snellen chart and three selected Smartphone visual acuity applications sequentially. A semi-structured questionnaire was used for data collection and then analysed using SPSS version 23.Results:A total of 287 patients were studied. Majority (96%) of the patients found the Smartphone apps to be easy to use. A good proportion (76%) of the patients also believed that Smartphone charts were easier to use than the conventional Snellen chart and expressed willingness to use the app again.Conclusion:Smartphone visual acuity apps could offer a convenient, easy-to-learn, and easy-to-use means of visual acuity assessment. This coupled with the demonstrated patient’s willingness to embrace this technology could be used to encourage the use of clinically validated apps for the early detection as well as monitoring of any impairment of vision, especially in out-of-clinic situations.