Ophthalmic Care Research Articles

Evaluation of the Clinical Impact of a Smartphone Application for Cataract Detection.

Background Approximately 10 million people in India suffer from bilateral blindness, with cataracts accounting for roughly 70% of these cases. However, there is a severe scarcity of ophthalmologists in India (12,000 across the country), which makes routine cataract screening very difficult, particularly in rural areas. To tackle this problem, we investigated the use of an artificial intelligence (AI)-based application for cataract screening at All India Institute of Medical Sciences (AIIMS), Bibinagar, that can be used by nursing officers and other healthcare professionals as a primary screening tool. Ophthalmologists from AIIMS Bibinagar additionally validate the results of this application. Purpose The aim of this study was to assess the clinical performance of a smartphone-based cataract screening application that uses an AI module to identify cataracts in photos taken with the device's camera. The study compared the application's results with diagnoses made by ophthalmologists using a slit lamp. Methods At AIIMS Bibinagar, 495 patients participated in a prospective clinical trial. The AI-based screening solution examined smartphone images that were taken in accordance with a set protocol to identify whether cataracts were present. The results of the application were then compared with the diagnoses made by ophthalmologists based on slit-lamp tests. Results The study included 990 eye images. The AI screening application demonstrated an overall accuracy of 90.01% for cataract detection. Specific metrics include a sensitivity of 89.50%, specificity of 89.73%, precision of 91.43%, and an F1 score of 90.36%. The positive predictive value (PPV) was approximately 91.3%, based on 485 true positives and 46 false positives. The negative predictive value (NPV) was approximately 87.6%, based on 402 true negatives and 57 false negatives. Conclusions The smartphone-based cataract screening application proves to be an effective tool for community-level cataract screening in remote areas where access to expensive equipment and specialized ophthalmic care is limited. Its high accuracy and efficiency make it a valuable option for low-resource settings and suitable for home screening, particularly in the post-COVID era.

Revolutionizing Ophthalmic Care: The Impact of Artificial Intelligence

Revolutionizing Ophthalmic Care: The Impact of Artificial Intelligence

Practical Tips for Starting a Student-Run Free Eye Clinic

Student-run free clinics serve three primary functions: 1) providing basic medical services for the uninsured and underserved in our communities, 2) supporting the training of medical providers, and 3) advocating for medically underserved communities. Despite the multiple benefits that student-run free clinics can provide, the process of founding a clinic is a significant challenge, even for highly motivated students. Here, we present 12 tips generated by students and residents at the University of Cincinnati College of Medicine based on their combined experience in founding the Bearcat Eye Service (BES), a clinic that provides basic ophthalmic screenings. These tips were developed to provide a framework for those interested in founding a student-run free clinic or expanding ophthalmic care in their communities.

Establishing Vitreoretinal Surgery Capacity in Sierra Leone: Challenges and Opportunities to Address Retinal Health Disparities in Resource-limited Settings.

A range of challenges exists regarding vitreoretinal (VR) surgical services in resource-limited settings, including Sierra Leone. As a result, retinal pathologies may contribute to vision loss and blindness. In the wake of the 2013 to 2016 outbreak of Ebola virus disease in West Africa, gaps in ophthalmic care were underscored as survivors were experiencing a constellation of sequelae, including uveitis and VR disease. Given the unmet needs in addressing VR disease, systems for retinal surgical care were required. To further understand long-term ocular complications in Ebola survivors and molecular and immunologic factors associated with this, research infrastructure was developed for retinal evaluation and surgery. The 5 "S'" framework was implemented and considered staff, space, stuff, systems, and social support. The ongoing development of retinal health infrastructure has helped to address challenges related to program implementation, development of surgical capacity, and alignment with local stakeholders and collaborator objectives. VR surgical services have been established in Sierra Leone through multidisciplinary partnerships and collaboration and serve patients in-country, as well as others in West Africa who have traveled for care. Continued engagement across stakeholders can aim to address challenges and promote effective care delivery.

Corneal and Conjunctival Abnormalities in a Cohort of Survivors from the Western African Ebola Virus Disease Outbreak

PurposeTo characterize corneal and conjunctival abnormalities (CCAs) and their impact on visual acuity in a cohort of survivors from the Western African Ebola virus disease (EVD) outbreak. DesignA post hoc analysis of 121 patients, who had previously undergone screening for the Ebola Virus Persistence in Ocular Tissues and Fluids study, was performed. MethodsPatients underwent a comprehensive ophthalmic exam at the Lowell and Ruth Gess Eye Hospital in Freetown, Sierra Leone. Demographic (including age, sex, and the number of days spent in the Ebola treatment unit and examination (such as visual acuity, and ocular complications) data were collected and used for the analysis. Visual acuity was either uncorrected or corrected with spectacles. Descriptive and inferential statistical analyses were performed, and a p-value < 0.05 was considered statistically significant. ResultsA total of 242 eyes (121 patients) were included in this study. The mean age was 31.5 ± 16.1 years, and 70% were female. Of 242 eyes, 28 (11.5%) eyes of 15 patients (12.4%) presented with at least one or more corneal or conjunctival abnormalities. Within eyes that demonstrated CCAs, the findings included dry eye (28.6% of eyes), band keratopathy (25% of eyes), and corneal scar (21.4% of eyes). Corneal edema was found in 14.3% of eyes, while pterygium and epithelial bullae were each found in 7.1% of affected eyes. Patients without CCAs had better visual acuity compared to patients with CCAs although the difference was not statistically significant (0.82 ± 1.17 vs 1.01 ± 1.29, p=0.4). A subset of patients with CCAs also reported ocular symptoms including eye pain, light sensitivity, excessive tearing, and blurry vision. ConclusionIn this post hoc analysis, we observed CCAs in 12% of EVD survivors. These findings highlight the potential for corneal and conjunctival sequelae during EVD survivorship and the need for ongoing ophthalmic care for this vulnerable population.

Global Health Security in Vision Care: Health Systems Strengthening During Ebola Virus Disease Outbreak Responses.

During the last decade, global health security has been threatened by major Ebola virus disease outbreaks in Western Africa (2014 to 2016) and in eastern Democratic Republic of the Congo (2018 to 2020). Particularly in Western Africa, the outbreak initially overwhelmed health care capacity in already fragile health systems. Thousands of survivors were at risk of newly recognized postacute ocular complications, and their need for urgent ophthalmic care challenged national vision health systems with scarce eye care services. In these unprecedently large outbreaks with implications for global health security, agile eye care responses were challenging, including in regard to decision coordination and requisite logistical needs. In this report, we detail vision care initiatives implemented in response to these outbreaks and highlight the need to include vision care as a critical component of the response to infectious disease outbreaks with eye health implications.

Screening for Eye Disease in Ebola Virus Disease Survivors: Program Implementation During an Active Outbreak in the North Kivu and Ituri Provinces, Democratic Republic of the Congo.

First identified in the Democratic Republic of the Congo (DRC, formerly Zaire) in 1976, Ebola virus disease (EVD) outbreaks have afflicted thousands of Congolese over the past several decades. The nation's largest outbreak of EVD in 2018-2020 was complicated by security challenges as well as large case numbers across an expansive geographic region. These factors provided challenges for logistical considerations as well as clinical coverage. In conjunction with the EVD survivor care program spearheaded by the Ministry of Health in DRC, the DRC Intitut National de Recherche Biomédicale, (DRC Institut National de Recherche Biomedicale, DRC National Institute of Biomedical Research) and others, we launched a multidimensional effort to provide ophthalmic care to EVD survivors. During the engagement period, 237 EVD survivors were screened, 56% of which were women. The 237 EVD survivors constituted ∼75% of the total EVD survivors who were discharged at the time of the intervention. The mean time from EVD symptom onset to evaluation was 4.6 months ± 1.8 SD (range: 24d to 8.5mo). Ninety-seven (41%) of EVD survivors screened reported ocular symptoms during or after acute illness, such as itchy eyes (49%), eye pain (25%), and tears (24%). Ophthalmic findings, including retinal scarring, active uveitis, dry eye disease, cataracts, and glaucoma, were also identified. The need for continued monitoring and longitudinal care for EVD survivors is evident from the expanding body of literature pertaining to post-acute sequelae, including ophthalmic manifestations. Initiatives for such care should be conducted across and in conjunction with multidisciplinary stakeholders for contextualization and effectiveness.

Investigating a novel therapeutic composition for dry eye syndrome management: In vitro and in vivo studies

Dry eye syndrome (DES) presents a significant challenge in ophthalmic care, necessitating innovative approaches for effective management. This research article introduces a multifaceted strategy to address DES through the development of ocular inserts utilizing advanced technologies such as hot-melt extrusion (HME) and the CaliCut post-extrusion system. The formulation includes key ingredients targeting different layers of the tear film and associated inflammation, including hydroxypropyl cellulose (HPC), polyethylene glycol (PEG), castor oil, and dexamethasone. The study incorporates a Design of Experiments (DoE) approach, integrating HME and the precise stretching and cutting technique of CaliCut for manufacturing consistency and dimensional control of the inserts. The developed insert(s) have been systematically characterized for their physicochemical properties, release profile, and in vivo efficacy. In silico molecular docking studies have also been conducted to assess the binding affinities of formulation components with ocular mucin, elucidating their binding affinities. Preliminary results demonstrate promising potential for the developed insert in managing DES, offering preservative-free treatment, sustained drug delivery, and improved patient compliance. This study highlights the integration of advanced technologies and formulation strategies in ocular drug delivery for effective DES management.

Photobiomodulation in Ophthalmology: A Comprehensive Review of Bench-to-Bedside Research and Clinical Integration.

Photobiomodulation (PBM), also known as low-level laser therapy, is an emerging therapeutic modality in ophthalmology, attracting increasing interest for its potential to manage a variety of ocular conditions. PBM employs low-energy light within the red and near-infrared spectrum to penetrate biological tissues, where it interacts with cellular chromophores. This interaction is believed to enhance mitochondrial function, boost adenosine triphosphate (ATP) production, and reduce oxidative stress, leading to improved cellular repair and tissue regeneration. Recent bench research has demonstrated PBM's efficacy in cellular and animal models, showing its ability to modulate inflammatory processes and promote healing in retinal and corneal diseases. For instance, in retinal models, PBM has been observed to reduce apoptosis and support cell survival under stress conditions. Similarly, studies in corneal models suggest that PBM can accelerate wound healing and reduce scarring. Clinical trials further corroborate these findings, revealing that PBM can enhance treatment outcomes in several ocular diseases, including age-related macular degeneration, diabetic retinopathy, and dry eye disease. Patients undergoing PBM have reported improvements in visual acuity, reduced retinal inflammation, and better tear film stability, highlighting its potential as an adjunctive therapy. This review also explores the integration of PBM into clinical practice, discussing current treatment protocols, safety considerations, and the latest advancements in PBM technology. By offering a holistic overview, the review aims to provide clinicians and researchers with valuable insights into PBM's role in modern ophthalmic care, emphasizing its potential to enhance treatment strategies and improve patient outcomes.

Application of Artificial Intelligence in Ophthalmology: An Updated Comprehensive Review.

Artificial intelligence (AI) holds immense promise for transforming ophthalmic care through automated screening, precision diagnostics, and optimized treatment planning. This paper reviews recent advances and challenges in applying AI techniques such as machine learning and deep learning to major eye diseases. In diabetic retinopathy, AI algorithms analyze retinal images to accurately identify lesions, which helps clinicians in ophthalmology practice. Systems like IDx-DR (IDx Technologies Inc, USA) are FDA-approved for autonomous detection of referable diabetic retinopathy. For glaucoma, deep learning models assess optic nerve head morphology in fundus photographs to detect damage. In age-related macular degeneration, AI can quantify drusen and diagnose disease severity from both color fundus and optical coherence tomography images. AI has also been used in screening for retinopathy of prematurity, keratoconus, and dry eye disease. Beyond screening, AI can aid treatment decisions by forecasting disease progression and anti-VEGF response. However, potential limitations such as the quality and diversity of training data, lack of rigorous clinical validation, and challenges in regulatory approval and clinician trust must be addressed for the widespread adoption of AI. Two other significant hurdles include the integration of AI into existing clinical workflows and ensuring transparency in AI decision-making processes. With continued research to address these limitations, AI promises to enable earlier diagnosis, optimized resource allocation, personalized treatment, and improved patient outcomes. Besides, synergistic human-AI systems could set a new standard for evidence-based, precise ophthalmic care.

OCTA: Essential or Gimmick?

This commentary article delves into the transformative role of optical coherence tomography angiography (OCTA) in diagnosing and managing a wide array of eye conditions, including diabetic retinopathy, age-related macular degeneration, retinal vein occlusions, and white dot syndromes. Developed in 2005, OCTA has emerged as a non-invasive, high-resolution imaging technique that offers advantages over traditional fluorescein angiography (FA), providing quicker and safer monitoring of ocular conditions with similar diagnostic accuracy. In diabetic retinopathy, OCTA has been instrumental in early identification of retinal changes, offering quantifiable metrics including perfused capillary density (PCD) for assessing vascular alterations. For age-related macular degeneration (AMD), OCTA has deepened our understanding of non-exudative neovascular AMD, allowing for more effective monitoring and potential earlier initiation of treatment. In cases of retinal vein occlusions, OCTA can reveal specific microvascular features and allow for depth-resolved measurements of the foveal avascular zone, providing significant prognostic implications. OCTA has also been invaluable in studying rare white dot syndromes, enabling nuanced differentiation between conditions that often present similarly. Emerging research also suggests that OCTA can have potential utility in neurodegenerative diseases like Alzheimer's, where retinal vascular patterns could offer diagnostic insights. While OCTA is revolutionizing ophthalmic care, further clinical trials and standardization are needed for its broader adoption into clinical practice.

CDC consultations related to ophthalmic practices and settings, January 2016-December 2023.

Consultations with the Centers for Disease Control and Prevention's Division of Healthcare Quality Promotion revealed patient harms associated with ophthalmic care. Adherence to core infection prevention and control principles, tailored guidance for ophthalmic settings, and compliance with manufacturing and compounding standards could decrease adverse events and patient exposures to contaminated products.

The Rise of Ophthalmology as a Specialty: Albrecht von Graefe's Pioneering Contributions.

Albrecht von Graefe (1828-1870) is celebrated as a pivotal figure in the evolution of ophthalmology. He is renowned for his transformative contributions that established the field as a distinct medical specialty separate from general surgery. This biography review delves into von Graefe's pioneering efforts that reshaped ophthalmology, highlighting his innovations and establishing fundamental practices that define modern ophthalmic care. von Graefe's introduction of iridectomy for glaucoma, development of specialized surgical instruments, and advocacy for the use of the ophthalmoscope marked significant advancements in treating eye disorders. Additionally, his role in founding the first ophthalmological society and journal underscored his commitment to creating a structured, scientific approach to the field. Through meticulous examination of his work and its impact, this article underscores how von Graefe's pioneering spirit and dedication fostered the growth of ophthalmology into an independent and respected medical specialty.

Advances in the diagnosis of ocular diseases: an innovative approach through an expert system

In the context of ophthalmic care, where early diagnosis of eye disorders plays a crucial role in patients' quality of life, this study focused on the development and evaluation of an expert system based on SWI Prolog. The main objective of this research was to provide an effective method for the preliminary diagnosis of ocular disorders, including cataract, trachoma, uveitis, glaucoma, and presbyopia. For the evaluation of the system, a confusion matrix was implemented and accuracy, sensitivity and specificity were calculated using a sample of 30 cases, of which 20 were positive and 10 negatives. The findings revealed an outstanding accuracy of 95%, with a sensitivity and specificity of 90%. This highlights the potential of the tool as an effective means of early detection of visual problems. In conclusion, this expert system represents a significant advance in ophthalmologic diagnosis, with important implications for clinical care and patients' quality of life, although expansion and validation of the tool in further clinical studies is suggested for its wider and more successful implementation in the field of ophthalmology.

Disparities in glaucoma and macular degeneration healthcare utilization among persons living with dementia in the United States.

Dementia is common among patients with primary open angle glaucoma (POAG) and neovascular age-related macular degeneration (nAMD). This study compares visit frequency, diagnostic test utilization, and treatment patterns for POAG and nAMD among persons with vs. without dementia. Optum's de-identified Clinformatics® Data Mart Database (January 1, 2000-June 30, 2022) was used for this study. Two cohorts were created from newly diagnosed POAG or nAMD patients. Within each cohort, an exposure cohort was created of newly diagnosed dementia patients. The primary outcome was the number of visits to an eye care provider. Secondary analyses for the POAG cohort assessed the number of visual field tests, optical coherence tomography (OCT), and glaucoma medication prescription coverage. The secondary analysis for the nAMD cohort included the number of injections performed. Poisson regression was used to determine the relative rates of outcomes. POAG patients with dementia had reduced rates of eye care visits (RR 0.76, 95% CI: 0.75-0.77), lower rates of testing utilization for visual fields (RR 0.66, 95% CI: 0.63-0.68) and OCT (RR 0.67, 95% CI: 0.64-0.69), and a lower rate of glaucoma prescription medication coverage (RR 0.83, 95% CI: 0.83-0.83). nAMD patients with dementia had reduced rates of eye care visits (RR 0.74, 95% CI: 0.70-0.79) and received fewer intravitreal injections (RR 0.64, 95% CI: 0.58-0.69) than those without dementia. POAG and nAMD patients with dementia obtained less eye care and less monitoring and treatment of their disease. These findings suggest that this population may be vulnerable to gaps in ophthalmic care.

Advancements in Ophthalmic Healthcare with Deep Learning-Driven Segmentation for Multi-Stage Eye Fundus Disease Diagnosis

The global rise in eye diseases highlights the need for advanced diagnostic tools in ophthalmic care. This project introduces a deep learning model for classifying eye diseases, streamlining diagnosis, and improving accuracy. Using real-time images from reputable healthcare facilities like Bajwa Hospital in Punjab and Shang gong Medical Tech in China, the model is fine-tuned to clinical nuances. Segmentation of the optic disc and blood vessels is key for precise retinal structure delineation, enhancing disease identification. Various CNN models, including Mobile Net, Dense Net, Reset, and a custom CNN, were utilized for retinal image analysis. Additionally, the Vision Transformer (ViT) model was integrated to capture intricate patterns. The model is deployed as a web application using Django, HTML, SQLite, and Bootstrap, featuring a secure, user-friendly interface. Users can input images to receive prompt disease predictions, along with verified information on prevention, treatment options, and medications. This system not only automates and improves diagnostic processes but also provides reliable medical guidance.

How much can we learn from each other? Polish and Hungarian good practices in financing ophthalmology care as a proposal for implementation in Ukraine.

The article aims to compare payment schemes for cataract, glaucoma, vitrectomy, cornea transplantations, DME, and AMD across Hungary, Poland, and Ukraine, and to identify implementable practices in Ukraine within the context of ongoing healthcare reforms. Researchers used mixed-method research-with legal documents and data analysis on utilisation of ophthalmology services between 2010 and 2019 and in-depth semi structured interviews with fifteen health experts from Hungary, Poland, and Ukraine. Interviewees, five from each country, were representatives from healthcare providers and payers with at least 10 years' experience in ophthalmology care and knowledge about financing schemes in each country of residence. We identified significant differences in healthcare delivery and financing of ophthalmology services between Hungary and Poland, despite both countries rely on Diagnosis-Related Group (DRG) based systems for hospital care. Good practices for financing specific eye treatments like cataract, glaucoma, age-related macular degeneration (AMD), diabetic macular edema (DME), cornea transplantations, and vitrectomy are identified. The financing scheme, including financial products and incentives, can influence the volume of treatments. Access to ophthalmic care is a key concern, with differences in treatment schemes between Hungary (ambulatory care) and Poland (hospital care), leading to higher costs and the need for centralization of complex procedures like cornea transplantations. The article highlights the importance of incentivizing quality improvements and removing financial barriers in Poland, while Hungary should focus on continuous monitoring of treatment methods and flexibility in reimbursement. For Ukraine, the research findings are significant due to ongoing healthcare reform, and the country seeks optimal practices while considering the experiences of other countries.

Sociodemographic Factors Associated With Emergent Eye-Related Emergency Department Visits: A Multicenter Analysis

ObjectiveTo compare sociodemographic factors in patients presenting to the emergency department (ED) with emergent and non-emergent eye-related concerns. DesignCross-sectional multicenter study. Subjects60,677 patients with eye-related concerns who visited EDs at Bascom Palmer Eye Institute, Wills Eye Hospital, Massachusetts Eye and Ear, and Johns Hopkins Hospital/Wilmer Eye Institute from January 1st, 2019 until December 31st, 2019. MethodsDescriptive statistics were performed using STATA 17. Main Outcome Measures1) Sociodemographic factors associated with emergent diagnoses, 2) Visit patterns across ED settings (i.e. standard ED vs eye ED), and 3) the most common emergent and non-emergent diagnoses. ResultsA total of 60,677 eye-related ED encounters were included in the study, including 22,434 at Bascom Palmer Eye Institute, 16,124 at Wills Eye Hospital, 15,487 at Massachusetts Eye and Ear, and 6,632 at Johns Hopkins Hospital/Wilmer Eye Institute. Most patients had non-emergent diagnoses (56.7%). Males (OR 1.85, 95% CI 1.79-1.92) were more likely to have an emergent diagnosis than females. Patients with private/employer-based insurance (OR 0.88, 95% CI 0.81-0.96), Medicare (OR 0.80, 95% CI 0.72-0.87), and Medicaid (OR 0.81, 95% CI 0.74-0.89) were all less likely to have an emergent diagnosis than uninsured patients. Those with veteran/military insurance (OR 1.08, 95% CI 0.87-1.34) were equally likely to have an emergent diagnosis compared to uninsured patients. Non-White Hispanic patients (OR 1.26, 95% CI 1.12-1.42) were more likely to present with an emergent condition than White patients. Patient seen in the standard ED setting were more likely to have emergent diagnoses than those who visited standalone eye EDs (P < 0.001). The most common emergent diagnoses were corneal abrasion (12.97%), extraocular foreign body (7.61%), and corneal ulcer (7.06%). The most common non-emergent diagnoses were dry eye (7.90%), posterior vitreous detachment (7.76%), and chalazion (6.57%). ConclusionsED setting was associated with the acuity of patient diagnoses. Lack of insurance coverage and non-White Hispanic race/ethnicity were associated with emergent eye-related ED visits. Improving access to ophthalmic care in these populations may reduce the incidence of preventable eye emergencies related to untreated chronic conditions. This combined with measures to redirect non-emergent issues to outpatient clinics may alleviate ED overload.

Retrospective Analysis of Reasons for Presenting to Emergency Ophthalmic Care in Poland and the USA – Literature Review

Retrospective Analysis of Reasons for Presenting to Emergency Ophthalmic Care in Poland and the USA – Literature Review

Influence of COVID-19 pandemic on the cataract services in a district hospital

Purpose: In March 2020, COVID-19 was declared a pandemic by the World Health Organization. The COVID-19 pandemic significantly disrupted the healthcare system, including the number of elective ophthalmic procedures conducted worldwide, resulting in a large-scale deferment of cataract surgeries after the Malaysian government recommended to postpone all nonessential elective surgeries to minimise the virus transmission and to augment the hospital resources to cope with a surge in COVID-19 cases. This study assessed the influence and impact of the COVID-19 pandemic on the cataract services in a district hospital. Study design: Retrospective descriptive analysis. Methods: This study analysed cataract surgery services in the period between January 1, 2017 and 31 December 31, 2021. Data were extracted from the electronic medical records. The study population was further divided into 3 groups according to the COVID-19 pandemic status: pre-pandemic, lockdown and recovery phase. Results: A total of 8,125 eyes were included in this study. During the lockdown phase, there was a 42% decline in the number of surgeries done compared to the pre-COVID-19 phase. A higher number of patients (53.5%) presented with severe visual impairment or blindness during the lockdown phase as compared to 40.2% during the pre-COVID-19 phase. The number of lens-related complications was markedly higher (2.58%) during the lockdown phase, as compared to the pre-COVID-19 phase (0.64%). During the end of the recovery phase studied, there was an early increment in the number of surgeries done, surpassing that of the pre-COVID-19 phases. Conclusion: The COVID-19 pandemic caused a drastic reduction in the number of cataract surgeries performed during the lockdown phase, causing more patients to suffer from avoidable blindness due to cataract, and leading to a higher rate of lens-related complications. An intuitive approach and reorganisation of ophthalmic care services are essential in order to lessen the backlog without causing burnout among healthcare workers.