Ophthalmic Practice Research Articles

Современные методы оценки морфометрических и функциональных показателей при первичной глаукоме

In the article are presented analytical review of scientific articles devoted to the study of modern methods of diagnostics of primary glaucoma. On the basis of scientific articles, a review material was collected and systematized on diagnostic methods for studying morphometric and functional changes in primary glaucoma, which are used in modern ophthalmic practice. In recent years, the improvement and implementation of new high-tech modern diagnostic methods open up new opportunities for researchers and clinicians. Optical coherence tomography, OCT angiography, static perimetry make it possible, by comparing morphometric and functional parameters, to give a more complete, comprehensive assessment of pathological changes in the optic nerve head, in the macular region and at the level of the choriocapillaries. Prevention of glaucoma blindness largely depends on its early diagnosis based on the use of modern organizational and medical technologies. Key words: glaucoma, open-angle glaucoma, intraocular pressure, glaucomatous optic neuropathy, diagnostic methods.

Ophthalmic practice during COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19) pandemic has caused significant changes in ophthalmic practice. The initial strategy of strict restriction of elective activities has been replaced with various guidelines to revitalize ophthalmic procedures considering the new safety concerns. In this manuscript, we reviewed recent recommendations for ophthalmic practice in different fields of ophthalmology during the COVID-19 pandemic.

Optical Coherence Tomography-Angiography in Pediatric Ophthalmological Practice (Review)

Data from sources of domestic and foreign literature for 2016–2019 is presented in the review of literature. This data concerned of applying the method of optical coherent tomography-angiography in pediatric ophthalmic practice. OCT-A is a non-invasive research method, without the use of fluorescent dyes. The procedure is performed relatively quickly, with the possibility of additional repetition. The method allows to conduct visualization of the vascular network of the retina layer-by-layer, perform its quantitative analysis: to evaluate the density of the microvascular bed and measure the area of non-perfusion zones. Having appeared as a result of a qualitative modernization of OCT, a new method of visualization of vessels OCT-A is actively used in the diagnosis of pathologies such as glaucoma, diabetic retinopathy, post-thrombotic retinopathy, age-related macular degeneration, central serous chorioretinopathy, etc. In present time OCT-A being performed in adult medicine, it is actively used in various areas of pediatric ophthalmology. Presently, pediatric patients with diabetes mellitus, sickle cell anemia, amblyopia, retinal artery occlusion, and coats disease have been performed with OCT-A studies. Retinopathy of prematurity (ROP) is required a special attention among children’s eye diseases. However, mentioning about OCT angiographic studies in patients with ROP are quite rare in the literature. Nevertheless, the available data indicate the enormous diagnostic potential of OCT-A in this severe vasoproliferative disease. The method give possibility for fully control the pathological process, to evaluate the effectiveness of the treatment and timely prevent the development of severe stages of ROP. Due to the information and diagnostic potential, it is necessary to continue research on the possibilities of the OCT-A method in the diagnosis, analysis of treatment results and prediction of ROP.

Ophthalmic practice during the coronavirus disease 2019 pandemic

Purpose To assess the adherence of ophthalmologists to the current recommendations during the coronavirus disease 2019 pandemic in the real-life practice and the measures taken by different institutions to decrease the risk of infection. Methods A cross-sectional study among ophthalmologists that was done via a self-administered web-based survey with 25 questions, starting with demographic data, followed by questions regarding the effect of the pandemic on practice. After that, detailed questions about infection control measures taken by different facilities and the use of various personal protective equipment and their availability were asked. Results We received 106 responses to the survey. Most of the respondents (86.8%) reported a reduction in the number of patients in the outpatient clinics, 49% limited services to emergencies, 50% reported triage for all patients, and 28% only reported providing face masks for patients. All our participants wear masks either surgical or filtering, 67% always use slit-lamp shields, and 75.5% apply hand hygiene per patient. The availability of various personal protective equipment and disinfectants was reported by 72% of our participants. Conclusion Real-life practice differs from the theoretical recommendations. Extra measures are required regarding patients’ triage, availability, and use of slit-lamp shields, face shields, and goggles. A stricter hand hygiene policy needs to be implemented and monitored.

Digital therapeutic improves visual acuity and encourages high adherence in amblyopic children in open-label pilot study

The effectiveness of amblyopia therapy can be limited by poor adherence. Dichoptic therapies are a new approach, but recent trials have demonstrated difficulty maintaining high adherence over extended periods of at-home treatment. We evaluated the efficacy and adherence of Luminopia One-a dichoptic treatment that applies therapeutic modifications to streaming content chosen by the patient. This single-arm, multicenter prospective pilot study enrolled children aged 4-12 with anisometropic, strabismic, or mixed amblyopia at 10 pediatric ophthalmic and optometric practices across the United States. The therapeutic was prescribed for 1hour/day, 6days/week for 12weeks of at-home use. The primary endpoint was best-corrected visual acuity (BCVA) at the 12-week follow-up visit. In total, 90 participants (mean age, 6.7±2.0years) were enrolled, and 73/90 participants (81%) had prior treatment beyond refractive correction. For those who completed the 12-week visit, mean amblyopic eye BCVA improved from 0.50 logMAR to 0.35 logMAR (1.5 logMAR lines; 95% CI, 1.2-1.8 lines; P<0.0001). Mean stereoacuity improved by 0.28 log arcsec (95% CI, 0.14-0.42 log arcsec; P<0.0001). Median adherence was 86% (interquartile range, 70%-97%). In our study cohort, adherence over the 12-week study period was high, and participants demonstrated clinically and statistically significant improvements in visual acuity and stereoacuity.

Особенности офтальмологических заболеваний при инфекции COVID-19

Before ophthalmic science and practice, the COVID-19 pandemic has identified a number of challenges. Aim. Сlinical and statistical analysis of eye pathology in patients admitted to the ophthalmology department during the incubation period of a new coronovirus infection for routine and emergency care, as well as in persons who have undergone COVID-19, with a demonstration of clinical observation. Materials and methods. 24 medical records of patients of the specialized ophthalmology department in the State Medical Institution of the “OKB No. 2” were retrospectively analyzed. The study period is from April 2020 to February 2021. A total of 24 patients received treatment, of which two-thirds were men Results. The structure of nosologies is presented as follows: inflammatory diseases 33.4%; injuries of the eyeball and their consequences 25%; retinal detachment 12.5%; glaucoma 12.5%; vascular pathology 8.3%; cataract 8.3%. Eye injuries – severe contusions and their consequences 16.7%. Nosologies that occurred in patients for the first time: neuritis of the optic nerve of both eyes, partial thrombosis of the upper-temporal branch of the central retinal vein of the left eye, hemophthalmos of the right eye, phlegmon of the orbit of the right eye, purulent ulcer of the cornea of the left eye, uncompensated, first detected, glaucoma of both eyes. Clinical manifestations of coronavirus infection occurred in 37.5% of patients who received specialized surgical treatment, including high-tech treatment for cataracts, glaucoma and retinal detachment in the early postoperative period. Somatic pathology was represented by: arterial hypertension in 37.5% of patients; type 2 diabetes mellitus and atherosclerosis with the same frequency-29.2% of patients. Anemia, diseases of the gastrointestinal tract, hepatitis and chronic lung pathology also occurred with the same frequency – 8.3% of patients. Conclusions. Patients may be admitted to the ophthalmology department during the incubation period of coronovirus infection. Acute conditions of the eyeball (retinal vein thrombosis, hemophthalmos, changes in the optic nerve, retinovasculitis) from our point of view belong to the initial manifestations of a new coronovirus infection.

Применение лентикулярной ткани в рефракционной хирургии роговицы

Purpose. To identify the problems of using lenticular tissue, its storage, obtaining cell-free scaffolds in corneal tissue engineering, and the possibility of predicting refraction. The unique advantage of Relex Smile technology is that it is a potentially reversible procedure that allows preserve the extracted lenticules and opens up broad possibilities for the use of lenticules in ophthalmic practice in the future. Research in this area demonstrated the potential for implanted autologous and allogeneic lenticules after creating an intracorneal pocket for treating diseases such as presbyopia, corneal perforation, corneal keratectasia, progressive pterygium, progressive keratoconus. In addition, this article presents the results of recent studies describing protocols for cryopreservation and decellularization of lenticules as the most promising methods in tissue engineering in conditions a shortage of donor's cornea. Key words: Relex Smile, lenticule, implantation, cryopreservation, decellularization, tissue engineering.

Effect of COVID-19-related lockdown on ophthalmic practice in Italy: A report from 39 institutional centers.

To compare the number of eye surgical procedures performed in Italy in the 2 months following the beginning of lockdown (study period) because of COVID-19 epidemic with those performed in the two earlier months of the same year (intra-year control) and in the period of 2019 corresponding to the lockdown (inter-year control). Retrospective analysis of surgical procedures carried out at 39 Academic hospitals. A distinction was made between elective and urgent procedures. Intravitreal injections were also considered. Percentages for all surgical procedures and incidence rate ratios (IRR) for rhegmatogenous retinal detachment (RRD) events were calculated. A p value <0.05 was considered significant. A total of 20,886 versus 55,259 and 56,640 patients underwent surgery during the lockdown versus intra-and inter-year control periods, respectively. During the lockdown, only 70% of patients for whom an operation/intravitreal injection was recommended, finally underwent surgery; the remaining patients did not attend because afraid of getting infected at the hospital (23%), taking public transportation (6.5%), or unavailable swabs (0.5%). Elective surgeries were reduced by 96.2% and 96.4%, urgent surgeries by 49.7% and 50.2%, and intravitreal injections by 48.5% and 48.6% in the lockdown period in comparison to intra-year and inter-year control periods, respectively. IRRs for RRDs during lockdown dropped significantly in comparison with intra- and inter-year control periods (CI: 0.65-0.80 and 0.61-0.75, respectively, p < 0.001 for both). This study provides a quantitative analysis of the reduction of eye surgical procedures performed in Italy because of the COVID-19 epidemic.

Spectacle non-tolerance in clinical practice - a systematic review with meta-analysis.

Spectacle non-tolerance or adverse events to spectacle wear are serious concerns for both patients and practitioners. Non-tolerance may contribute to a negative impact on the practitioner's ability and practice. Therefore, a detailed understanding of frequency and causes of spectacle non-tolerance in clinical ophthalmic practice is essential. This review aimed to determine the prevalence and causes of non-tolerance to spectacles prescribed and dispensed in clinical practice. The current systematic review included quantitative studies published in the English language that reported spectacle non-tolerance in clinical practice. A comprehensive search was conducted in PubMed, Scopus and the Web of Science database for studies published until 13 July 2020. An adapted version of the Newcastle-Ottawa Scale (NOS) modified for cross-sectional studies was used to assess the quality of each included study. Five investigations with 205,478 study participants were included in the review. The prevalence of spectacle non-tolerance from individual studies was pooled using MetaXL software. The pooled prevalence of spectacle non-tolerance was 2.1% (95% CI: 1.6-2.7) ranging from 1.6% to 3.0%. The papers were also reviewed to identify the potential causes of non-tolerances. Nearly half reported that non-tolerance (47.4%) was due to an error in refraction. Other causes identified were errors related to communication (16.3%), dispensing (13.5%), non-adaptation (9.7%), data entry (8.7%), binocular vision (7.4%) and ocular pathology (6.4%). This review improves our understanding of spectacle non-tolerance in clinical practice. This is important because non-tolerance may lead to spectacle wear discontinuation, which may deprive patients of optimal vision. Increased non-tolerance in clinical practice may affect a clinician's reputation and incur additional costs associated with reassessments and replacements. Spectacle non-tolerance occurred due to a multitude of factors related to optical dispensing and wearer adaptation. Therefore, there is a need for vigilance while prescribing spectacles. The limited evidence highlights the need for more studies, especially in limited-resource settings, to improve the quality of refractive error services.

Ophthalmology practice in Afghanistan during the COVID-19 pandemic.

This short communication described the actions taken in ophthalmic practice in Kabul, Afghanistan during the COVID-19 pandemic to effectively protect both patients and staff. By following World Health Organisation (WHO), international and local guidelines it has been possible to continue treating ophthalmic outpatients with minimum risk to both patients and staff. The changes which have been implemented may allow better overall infection control in the hospital which will continue to have benefits post-pandemic.

The impact of COVID-19 lockdown on cataract surgery: a surgeons’ perspective

ABSTRACT Clinical relevance In the last months, the whole world is dealing with an unprecedented public health crisis due to COVID-19 outbreak. Consequently, many governments have implemented lockdowns on a national level, affecting, among others, ophthalmic surgical practice in a globe scale. Background The aim of this study is to evaluate the impact of surgical theatre lockdown due to COVID-19 pandemic on the surgical performance of cataract surgeons. Methods Intraoperative complications and surgical time of the first 160 cataract surgeries performed by eight consultants (20 cases each) after a two-month lockdown were recorded and analysed in a cross-sectional study. The results were plotted against the last 30 cases of each surgeon before the implementation of the lockdown (240 cases). Cataract surgeons were asked to rate their subjective perspective and difficulties faced after re-opening through a questionnaire. Results The average duration of all surgeries after the lockdown was 19.1 ± 6.2 minutes showing a 14% increase compared to the one before the lockdown (16.8 ± 5.1 minutes, p = 0.0001). The complications rate was 2.09% (5/240 cases) before the abstention and 3.12% (5/160 cases) after the abstention not yielding any statistically significant difference (p = 0.74). When complicated surgeries were excluded from the analysis, surgical time was still higher after the lockdown (18.9 ± 5.9 minutes) than before (16.6 ± 5.0 minutes, p < 0.0001). 37.5% of consultants (3/8) stated that the two-month abstention from cataract surgeries has affected their surgical skills somewhat or a lot, while 62.5% (5/8) reported being more careful in their first cases after the lockdown. Most complications occurred in the hands of one surgeon who stated to be very anxious upon restart. Conclusion The operating theatres’ lockdown due to COVID-19 pandemic did not seem to affect the intraoperative complications rate in cataract surgery. A slight increase of surgical duration was noted, while most surgeons reported being more careful upon restart.

Risk and prevention of COVID-19 in ophthalmic practice

The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported in China in December 2019. Recent reports have confirmed that SARS-CoV-2 is primarily transmitted through secretions of the respiratory tract; however, it remains controversial whether or not COVID-19 affects the eye. This study presents a review of current evidence related to ocular transmission of SARS-CoV-2 for gaining a better understanding of the ocular manifestations of patients with COVID-19. The study also summarizes appropriate measures to be taken to protect healthcare providers in the ophthalmology department from being exposed to infected tears or conjunctival secretions. Some studies reported that SARS-CoV-2 can be transmitted through infected tears and conjunctival secretions of patients with COVID-19. Ocular manifestations such as injection, increased discharge, or epiphora, which are consistent with those of viral conjunctivitis, are more commonly reported. Therefore, during the ongoing COVID-19 pandemic, personnel working in the ophthalmology department should be provided with adequate and appropriate personal protection equipment. The exact mechanism and pathophysiology of ocular transmission of SARS-CoV-2 remain unclear, thus warranting further studies.

Continuing ophthalmology practice in crisis - Lessons from COVID-19 pandemic.

Dr. Li Wenliang, a fellow ophthalmologist from Wuhan, China had attempted to warn his colleagues of a novel severe acute respiratory illness ultimately succumbing to this novel disease on February 7, 2020.[1] Over the next few months, not only did the virus paralyze the world, but it managed to evolve into a pandemic of epic proportions which the new world had not seen since the Spanish flu. COVID-19 has adversely affected all aspects of life including medical care. The Ophthalmology department has been equally affected by the shut-down of smaller practices with complete cessation of elective surgeries such as refractive and cataract surgery. Due to the nationwide lockdown, most cases were being referred to higher centers which were still difficult to access due to the absence of transport and this impact of lockdown on ophthalmic practice was aptly described by Nair et al.[2] A study done in our center showed that ocular trauma surgeries followed by vitreoretinal surgeries were the two most commonly performed surgeries during the lockdown.[3] The demographics of these patients during lockdown was also emphasized with maximum patients being local in origin. It also highlighted the role of a dedicated hospital infection control committee (HICC) that not only implemented infection control practices but also provided active surveillance of any COVID-19 patients. We put forth the effectivity of novel concepts such as avoidance of contact procedures like applanation, direct ophthalmoscopy, use of breath-shields on slit lamps and indirect ophthalmoscope. Every patient presenting to our emergency department underwent detailed history taking and was provided with hand sanitizer and a surgical mask prior to contact with a health care worker (HCW). Not only did our center provide guidelines in managing vitreoretinal surgeries during the lockdown, we even described guidelines for management of intravitreal injections during the lockdown period and thereafter.[4] It was Unlock-I which was announced by the Government of India from June 8, 2020 that came as a respite not only for ophthalmologists nationwide but also for the patients. During Unlock-I centers resumed services other than emergencies with their own set of protocols. Pre-operative COVID testing became the norm in certain centers and was usually done within 72 h of the surgery. A positive COVID test mandated delay of elective surgeries as well as stringent contact tracing and risk assessment of any HCW exposed to the patient. These measures mitigated the risk of contracting COVID-19 among the HCW. Fixed percentage of HCW‘s of all specialities continued manning the COVID wards of hospitals. Even during Unlock-I there were tailored restrictions across state lines along with the constant fear of contracting COVID-19. Hence the reduced footfall of patients continued despite India entering Unlock-I. This brought forth unique challenges to hospitals with resident/fellow training programs. These new challenges required educational reform, policy making and restructuring of training programs.[5] The study published in this issue of the journal succinctly describes the trials and tribulations that were faced by ophthalmic practices not only in South India but also across the country.[6] The drastic decrease in new as well as follow-up patients and the reduction in surgeries has plagued ophthalmic practices across the board. The study has also ably described the causes leading to the drastic reduction of workload despite Unlock-I. Despite the greatest efforts of providing an entire network of eye care centers, there were still a few lacunae in providing permanent eye care closer to the communities which COVID-19 managed to exploit. Even the role of telemedicine in ophthalmology remains limited and should only be used to advise first-aid and triaging.[7] COVID-19 has brought forth the deficiencies in eye care provision to the vulnerable population. The need to develop permanent eye care facilities closer to the communities has now become of utmost importance and requires aggressive reforms for accessible eye care.

Chemical disinfectants in ophthalmic practice.

The instrumentation used in ophthalmic clinics can be a source of epidemics in health care set up. Contact tonometry with Schiotz or Applanation tonometer is associated with nosocomial epidemic keratoconjunctivitis outbreaks. Recently identified SARS-CoV-2 (COVID -19) spreads mainly via the respiratory route and fomites and can transmit through other body fluids, including tear film. Various ophthalmic instruments can become a common source of spreading cross infections. Chemical disinfection is one of the most common methods employed to decontaminate instruments and environmental surfaces and prevent transmission of infectious pathogens to patients through medical and surgical instruments. Various chemical disinfectants are available with a varied spectrum to work on a different group of organisms. In this article, we briefly cover commonly used chemical disinfectants in ophthalmic practice like Alcohol (Ethyl Alcohol, Isopropyl Alcohol), Chlorine-based solution (mainly Sodium Hypochlorite), Glutaraldehyde, Hydrogen Peroxide, Formaldehyde, Iodophors, and Quaternary Ammonium Compounds

Rare foreign bodies encountered in ophthalmic practice

Ocular trauma and retained foreign bodies in the eye form a common occurrence in ophthalmic practice. Mild trauma may often be overlooked and patients, quite often, present late with serious complications. The clinical presentations and management of three patients who presented with a FB in the anterior chamber, within the lens, and within the orbit, respectively, are discussed. The diagnostic and management issues are highlighted along with a brief review of relevant literature.

Ophthalmic practice in current COVID crisis

Corona virus (covid-19) pandemic has shaken the entire world, its wide spread transmission has restricted everybody's day to day life, ophthalmologists are no exception, but in greater danger, as most of ophthalmologic examinations include close contact between patient and doctor, increasing the risk of transmission of deadly covid-19 virus. Adopting certain measures in ophthalmic practice reduces the transmission risk. Various ophthalmic manifestations of covid 19 includes follicular conjunctivitis, viral keratoconjunctivitis, hemorrhagic and pseudomembranous conjunctivitis, Central retinal vein occlusion (CRVO), Central retinal artery occlusion (CRAO) Cerebrovascular accident (CVA) with vision loss, Mucormycosis etc. For this review, literature search was conducted in PubMed and Google Scholar databases by using terms coronavirus, SARS-CoV-2, COVID-19, ophthalmology, ophthalmologist, telemedicine in ophthalmology and their combinations to gather efficient information that can enhance the daily practice. Most important modifications include personal protective equipment, environmental measures (air ventilation, instrument handling), administrative measures (physical distancing, triage setup). Vaccination plays a crucial role in hampering the effect of covid crisis, it should be given significant importance and extensive awareness. Telemedicine can change the entire scenario in doctor-patient relationship and everyone should have thorough knowledge about its guidelines. All these measures need gigantic efforts in reducing the covid-19 effect, paving the path for the “NEW-NORMAL”.

Financial impact of covid-19 on ophthalmic practices

The unprecedented threat of Covid-19 has forced transition from the normal way of life. The new norm now includes social distancing, the use of face masks, and reduced contact to only necessary cases. In ophthalmology, practice

Пациент со слезотечением на приеме у врача-оториноларинголога

Lacrimation is one of the most common symptoms in ophthalmic practice. Most patients first visit an ophthalmologist, but the otorhinolaryngologist also plays an important role in determining the etiology of the disease and in the choice of management for such patients. This review presents a literature search that addresses the diagnosis and treatment of patients with epiphora. Identifying the cause of lacrimation is the main factor in making the correct diagnosis and choosing the optimal treatment method. Endonasal dacryocystorhinostomy is of particular importance. The multidisciplinary approach of the ophthalmologist and otorhinolaryngologist allows for the success of the epiphora treatment.

Nasopharyngeal carcinoma (NPC) in the ophthalmic practice: A serious neoplasm presenting initially to ophthalmologists.

PURPOSE:Nasopharyngeal carcinoma (NPC) is an aggressive malignant tumor that arises from the nasopharyngeal epithelial lining. Most patients with NPC present with a neck mass or cranial nerve palsy. It is infrequent for patients with NPC to present to an ophthalmologist initially with ophthalmic complaints and absence of prior diagnosis of NPC. We are reporting a series of six NPC cases that presented solely with ophthalmic complaints, to attract the attention of ophthalmologist to such a serious neoplasm.METHODS:A retrospective observational study of all consecutive patients diagnosed with NPC based on their initial ophthalmic presentation with no prior diagnosis of this neoplasm. Patients presented for the first time to two tertiary eye hospitals. Data were collected by the chart review for demographics, clinical presentation, radiological imaging, treatment regimen, and follow-up. Histopathological review of their tissue specimens was conducted by two pathologists.RESULTS:We had six patients who presented for the first time to our ophthalmic service complaining mostly of limitation of extraocular muscle motility with or without diplopia (4/6), orbital or facial pain (2/6), and disturbance in vision (2/6). The age ranged from 35 to 92 years with a mean of 58 years. A male predominance was observed with male-to-female ratio of 5:1. The cases are described along with their imaging and histopathological findings. Relevant literature review was also presented. Most of our patients (5/6) received combination of radiotherapy and chemotherapy. One patient refused treatment and 2 eventually passed away after 7 months.CONCLUSION:Ophthalmologists may play a major role in diagnosing such patients accurately and referring them for early management and better prognosis.

Anterior chamber angle foreign body masquerading as corneal edema

Open globe injuries (OGIs) with intraocular foreign bodies are a common presentation in ophthalmic practice. Foreign bodies in the angle of the anterior chamber have been described earlier. In this report, two such cases of foreign bodies in the angle, identified on gonioscopy, are described. One case presented with pain and redness of 6-month duration with trauma 3 years ago. Examination revealed corneal edema and a foreign body in the angle. In the other case, early gonioscopy was performed and an angle foreign body was identified. In both cases, the foreign bodies were removed with good visual results. An OGI with a foreign body embedded in the angle was the common feature in both cases which presented as late corneal edema in the first one. Thus, in cases of any OGIs, gonioscopy should be performed as early as possible, so that complications leading to visual loss can be prevented.