Ophthalmologic Consultation Research Articles

Association between central corneal thickness and systemic lupus erythematosus: a cross-sectional study protocol.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple systems and classified under connective tissue disorders. Ocular involvement occurs in up to 30% of SLE cases, with the cornea being particularly susceptible to thinning due to immune-complex deposits and its predominantly type I collagen composition. This corneal thinning is clinically significant in glaucoma, where patients with reduced central corneal thickness (CCT) may have up to a threefold increased risk of developing glaucoma, as well as in refractive surgery. However, existing studies on CCT in SLE are limited and marked by substantial heterogeneity in methodology, technology, criteria, and participant numbers, resulting in conflicting findings. Based in our hypothesis that SLE-related corneal lysis may result in decreased CCT, this study aims to determine and compare the mean CCT values between SLE patients and healthy controls to obtain a more precise understanding of the potential relationship. A cross-sectional observational study will be conducted, enrolling SLE patients and age-and sex-matched healthy controls recruited from ophthalmology consultations. Exclusion criteria will be applied to rule out other corneal thinning risk factors. A pilot study estimated a minimum sample size of 34 participants per group. CCT measurements will be obtained using Zeiss HD Cirrus 5,000 optical coherence tomography (OCT) on a randomly selected eye, following concordance analysis using the Kappa index. Statistical analysis will include descriptive, bivariate, and multivariate methods. The study protocol was approved by the ethics committee. The cornea's vulnerability to thinning and lysis in SLE, which impacts CCT, is crucial for the accurate assessment of glaucoma, the leading cause of irreversible blindness worldwide and the second leading cause in Europe. Given that patients with reduced CCT are at a significantly higher risk of developing glaucoma, further research is necessary to understand the association between SLE and CCT. Our study aims to enhance methodological rigor compared to prior research by determining an appropriate sample size and exclusively enrolling SLE patients to increase participant homogeneity. If a significant difference in CCT between groups and an association between CCT and SLE are found, a prospective study will be considered.

Understanding the Dry Eye Disease-Related Symptoms in South America: Prevalence and Associated Factors-A Systematic Review.

Background/Objectives: Dry eye disease is a leading cause of ophthalmologic consultations worldwide and can significantly impact quality of life. While global prevalence rates vary widely, data specific to South America are limited. This systematic review aims to describe and analyze the prevalence and associated factors of dry eye disease-related symptoms in South American populations. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted using databases such as PubMed, Web of Science, Scopus, and LILACS. Primary studies in English and Spanish that examined the prevalence of dry eye disease-related symptoms in South American populations and its associated factors were included without date restrictions. Studies were screened and selected based on predefined inclusion and exclusion criteria, resulting in the final inclusion of 16 studies from six South American countries. Results: This review identified significant variability in the prevalence of dry eye disease-related symptoms in South American populations in the region, ranging from 4% to 77.5%, with a mean prevalence of 39.3%. Higher prevalence rates were observed among specific groups, such as university students (58.6%) and administrative workers (57.9%). Factors associated with dry eye disease-related symptoms in South American populations included female sex, older age, prolonged screen time, insufficient sleep, and medical conditions such as hypertension, connective tissue disorders, and the use of medications like antihypertensives and antidepressants. Conclusions: The prevalence of dry eye disease-related symptoms in South American populations is notably higher than global averages, highlighting regional challenges. This study emphasizes the need for standardized diagnostic tools and comprehensive epidemiological research across South America, particularly in underrepresented countries, to inform public health strategies tailored to the specific needs of these populations.

Ocular Manifestations in Paediatric Erythema Multiforme: A Case Report

Erythema multiforme (EM) is a type IV cytotoxic hypersensitivity reaction characterized by classic target lesions on the skin and mucosa, typically affecting the oral, genital, and rarely, ocular mucosa. We describe a 9-year-old girl with widespread rashes, blisters and target lesions on her trunkfor three days. She had eye redness, discomfort, a week-long fever, and a dry cough, without any medication. Ophthalmological examination revealed localized conjunctival injection in her right eye, with no visual impairment or corneal lesions. The diagnosis of EM major (EMM) was based on prior infection, characteristic skin lesions, and mucosal involvement, including ocular manifestation of conjunctival injection. Treatment requires addressing the underlying cause and ophthalmologic consultation for systemic or topical corticosteroids, antibiotics, lubricants, and antihistamines. This case highlights the diagnostic challenges of atypical EM presentations, emphasizing the need for comprehensive evaluation, early recognition, and interdisciplinary collaboration to prevent severe ocular complications and preserve vision.

Online resources for strabismus: an evaluation of readability, complexity, and suitability.

Over one-third of US adults have never attended college, creating a large disparity in the readability of online health materials. Decreased health literacy and accessibility to medical information negatively affect patients and well-informed patients are more likely to experience better health outcomes (1). The NIH and AMA recommend patient-intended education materials be written at a sixth-grade reading level (2), therefore, this study analyzed the accessibility of the top ten web pages for "strabismus." The first ten online resources returned in a Google search for "strabismus" were analyzed. Web pages were then assessed for the readability level (Simple Measure of Gobbledygook), complexity (PMOSE/IKIRSCH), and suitability (Suitability Assessment of Materials). Two independent raters assessed the complexity and suitability. Readability analysis of the strabismus resources revealed an average reading grade level of 11.4 ± 1.07. There was a statistical difference in the reading grade level between the .com and .gov, and the .org and .com websites (p = .029 and p = .031, respectively). Complexity analysis revealed a mean score of 6.50 ± 2.29, corresponding to an 8th-12th grade reading level. The suitability assessment showed a mean value of 70.3 10.1%, representing a "superior" score for the information provided to the reader. The inter-rater agreement was similar for the complexity and fair for the suitability analysis. On average, online resources for strabismus have a low complexity level. However, the majority of the top ten articles reviewed are above the recommended literacy level, indicating a need for revision. The vast amount of available online health resources have significantly affected the field of medicine. Most patients research their disease process using online sources and many reference this material before their initial ophthalmologic consultation. Considering that more than half of Americans read below the equivalent of a sixth-grade level and that the AMA/NIH recommend all patient-intended materials to be written above this level, there is a health literacy disconnect. This limits patients' ability to educate themselves about their medical conditions and participate in informed conversations regarding their healthcare. Patients who are unable to interpret health information accurately have increased rates of hospitalization, develop more medical conditions, and experience a higher rate of mortality. This preventable impediment to informed healthcare care magnifies the urgency for easily readable online resources that are formatted in a manner that is clear to understand and suitable for patients with lower health literacy.

Bio-spectroscopic analysis of corneal structural alterations in dry eye disease: A study of collagen, co-enzymes, lipids, and proteins with emphasis on phytotherapy intervention

Dry eye disease (DED) stands as a prevalent cause for ophthalmology consultations, securing the third position following refractive errors and cataracts. Moreover, the likelihood of experiencing DED escalates with advancing age. In this experimental study corneal tissue alterations due to DED were investigated over different periods by applying both infrared and synchronous fluorescence spectroscopy. The potential effects of instillation of pomegranate and green tea water extracts as green-friendly treatment modalities were also evaluated. The obtained results collectively indicate that DED affects the OH bearing constituents (collagen, glycosaminoglycans, and proteoglycans) of cornea leading to changes in protein secondary structure and the collagen fibrils. Additionally, enhanced dehydrated environment, and reduced energetic/metabolic state, as indicated by co-enzymes, was observed. Phyto-therapeutic administration can contain these alterations with enhanced energetic/metabolic state and increased hydration environment. In conclusion, instillation of green tea extract can protect/restore the collagen fibrils and its potential effects, in general, exceeds that of pomegranate extract.

Glaucoma Surgery SOS: Emergency Department Utilization Greater among Younger and First-Time Surgical Patients with Glaucoma

PurposeTo describe the frequency, findings, and interventions of patients’ emergency department visits after all types of glaucoma surgery DesignRetrospective cohort study SubjectsAll surgical glaucoma patients between 2013 and 2021 MethodsThis single institution study collected demographics, surgery type, and surgical parameters for each patient. Subsequently, for those visiting the emergency department within 50 days of surgery, data was collected on reason for visit, findings, and ophthalmic intervention. Logistic regression models were used to determine the odds of ED visits based on multiple risk factors. Main outcomePostoperative presentation to ED ResultsAmong 9155 surgeries in 5505 patients, 5.7% had ED visits within 50 days, with 46.3% having ocular complaints. Patients with ocular diagnoses presented earlier than those without (p < 0.001). Patients who presented to the ED with an ocular diagnosis were found to be significantly younger than those who did not present (62.2 ± 18.6 vs 65.4 ± 18.0 years old, p < 0.028). Furthermore, white patients were more likely than black patients to present with an ocular diagnosis compared to a non-ocular diagnosis (OR 2.64, 95% CI 1.67-4.18, p<0.001). Patients undergoing their first glaucoma surgery had a much higher chance of presenting to the ED compared to patients who had undergone more than one surgery (OR: 3.75, 95%CI 2.74 – 5.14, p < 0.001). Those who underwent traditional surgeries were more likely than patients with trabecular meshwork bypass stent (TMBS) to present to the ED with an ocular diagnosis (OR: 3.02, 95% CI 1.29 – 7.08, p = 0.011). Filtering surgeries and glaucoma drainage device (GDD) revisions exhibited more vision-threatening conditions than glaucoma drainage devices (p = 0.037 and p = 0.010 respectively). Ophthalmology consultation was sought for 88.0% of ocular diagnoses. Most received medical therapy (71.0%), primarily IOP-lowering drops. ConclusionED visits after glaucoma surgery are infrequent, yet more often seen in younger patients or those undergoing their first glaucoma surgery. TMBS, but not trabecular meshwork excision and/or Schlemm’s canal dilation (TME/SCD), were less likely to present to the ED than traditional surgeries. Filtering surgeries and tube revisions presented more often with visual threatening conditions.

Télé-expertise en ophtalmologie au centre hospitalier universitaire de Rennes : évaluation de la plateforme sécurisée OMNIDOC au cours de sa première année d’utilisation

Ophthalmology as a specialty is a pioneer in the area of telemedicine. Remote consultation represents one of the 5 types of telemedicine services, with a growing volume of activity in university hospitals. In November 2020, the ophthalmology department of Rennes University Medical Center launched its remote consultation network with the secured platform OMNIDOC. The goal of this study was to assess its contribution during its first year of use. Beginning in November 2020, ophthalmology consults at Rennes University Medical Center were directed towards the dedicated OMNIDOC network. Three-hundred and forty-one requests for remote consultation were received and analyzed between November 2020 and October 2021. We sent a satisfaction survey to both the requesting and consultant physicians to assess whether or not the network was beneficial. Three-hundred and twenty-seven remote consultations requested by 126 practitioners were included in the study. The median response time was 6hours. Every field of the specialty was involved, of which 22.3% were for pediatric patients under 6years of age. Among the requests, 89.7% were regional (Brittany) and came mostly from ophthalmologists (61.77%). Nearly one out of two patients did not require an in-person consultation at Rennes University Medical Center. The implementation of a remote consultation network allowed access to a rapid, facilitated medical ophthalmology consultation. Such a platform delivers safety and traceability of the interactions. It enhances and optimizes the patients' care pathway and encourages relationships with community physicians.

Impact of 5 waves of COVID-19 on pediatric ophthalmology

ObjectiveTo characterize the impact of multiple waves of COVID-19 on pediatric ophthalmology at a tertiary care hospital. MethodsMedical records were reviewed from pediatric patients seen for ophthalmic emergencies at the Montreal Children's Hospital (Montreal, Canada) from 5 COVID-19 periods: March 13 to May 31, 2020; September 20, 2020, to February 21, 2021; March 21 to May 31, 2021; August 17 to November 5, 2021; and December 19, 2021, to January 25, 2022, as well as 2 pre-COVID time periods: March 13 to May 31, in 2018 and 2019). ResultsThere was a significant reduction in ophthalmic consultations when comparing pre-COVID to all 5 COVID waves (p < 0.0001). There was an increase in the average number of daily urgent (p = 0.01) ophthalmic consultations from waves 1 to 4. Mean household income of patients was not significantly different pre-COVID compared to during the 5 COVID waves (p = 0.96). The most common referral reason was ocular trauma (38.0% of cases). There was a non-significant trend demonstrating more infectious disease presentations during waves 3 to 5 (p = 0.07). There was no difference in symptom duration prior to presentation (p = 0.54); however, there was a difference in the time between emergency room and ophthalmology assessment in waves 3 and 4 compared with wave 5 (p = 0.003). ConclusionThe number of pediatric ophthalmology consultations was less during the 5 COVID waves than pre-COVID. An increase in urgent pediatric ophthalmology consultations occurred as COVID-19 infection rates in Quebec decreased. Access to health care and time to care were preserved across waves compared with pre-pandemic.

Perception and practices of obstetricians and ophthalmologists eye diseases during pregnancy

Aims: Cesarean delivery can be crucial for both the mother and the baby, with indications often stemming from fetal or maternal health concerns. In addition to obstetric factors, non-obstetric conditions such as eye diseases frequently necessitate cesarean delivery. Among the eye diseases commonly encountered during pregnancy are refractive errors, diabetic retinopathy, ocular malignancies, and glaucoma. Some of these conditions may exacerbate during pregnancy due to related health issues like diabetes or hypertension, or they may be aggravated by the stress of vaginal labor. Consequently, the decision regarding the continuation of pregnancy, the mode of delivery, and even the choice of anesthesia can vary depending on the specific eye disease and its severity or characteristics. The aim of this study was to assess the knowledge and attitudes of obstetricians regarding the management of pregnant women with different eye conditions, with the ultimate goal of increasing awareness among obstetricians. Methods: In this study, a total of 46 obstetricians and 30 ophthalmologists practicing in Turkiye were included. Participants were surveyed to gather information, as no existing survey or scale pertaining to our study subject was available. Therefore, a novel survey form was developed based on previous studies addressing similar topics, and this survey was administered to all participants. Results: During the study, both obstetricians and ophthalmologists were queried about the management of 17 distinct eye diseases occurring during pregnancy. Ophthalmologists advocated for normal vaginal delivery (NVD) in 13 out of the 17 eye diseases. On the other hand, obstetricians opted for NVD in 5 out of the 17 cases, while recommending ophthalmology consultation in 12 out of the 17 scenarios. Conclusion: It has been noted that ophthalmologists suggest vaginal birth in 9 out of 17 eye diseases, whereas obstetricians tend to recommend consulting ophthalmologists rather than making independent decisions. This trend may stem from the fact that obstetricians may lack sufficient knowledge about eye diseases, as these conditions are not primarily within the scope of pregnancy-related care. Additionally, obstetricians might be inclined to share responsibility, possibly due to the rise in malpractice cases against obstetricians in recent years in Turkiye.

The carbon footprint of French hospital ophthalmology consultations.

France carbon footprint, with 604 million tons of CO2 equivalent (CO2eq) annual emissions, far exceeds the worldwide scientific specifications to not exceed 2 °C of warming in 2100. The healthcare sector is one of the biggest contributors to greenhouse gas emissions. The aim of this study is to quantify and evaluate the carbon footprint of the consultation activity of an ophthalmology department at a single institution in France. The perimeter of the investigation included consultations and excluded the surgeries and the hospitalisation. We calculated the carbon footprint of a single day of practice in our scope of investigation. We included consumption of energy, patient travel, staff travel, pharmaceutics and medical devices purchases, computer hardware, biomedical equipment/exam materials, and waste. We used the official French public database of emission factors: Base Empreinte® of the Environmental and Energy Management Agency of France. The carbon footprint of a single day of our department was estimated at 1 688.65 kgCO2eq. It represents an average of 9.28 kgCO2eq per patient. Energy consumption contributed for 114.80 kgCO2eq (6.8%), travel for 1324.76 kgCO2eq (78.4%), pharmaceutics and medical devices for 208.33 kgCO2eq (12.3%), equipment for 14.38 kgCO2eq (0.9%) and waste for 26.38 kgCO2eq (1.6%). This study highlights the importance of patient travels, and possibly pharmaceutics, in the carbon footprint of hospital ophthalmology practice in France. More studies are needed to establish it at the national or international scale, as well as more carbon footprint analyses on products, especially those of high prices, to increase the accuracy of these studies.

Ocular Manifestations and Complications of Patent Foramen Ovale: A Narrative Review.

Patent foramen ovale (PFO) is a prevalent congenital cardiac anomaly associated with a persistent opening between the atrial septum, allowing communication between the left and right atria. Despite often being asymptomatic, PFO can lead to various clinical presentations, including cryptogenic stroke and other embolic events. Transient visual disturbances, alterations in the visual field, migraine with aura, impaired eye movement and endogenous eye infections may prompt patients to seek ophthalmological consultation. Understanding these diverse clinical scenarios is crucial for early detection, appropriate management and mitigating the morbidity burden associated with PFO. This narrative review aims at examining the spectrum of clinical presentations of ocular pictures associated with PFO. The pathophysiology, diagnosis and treatment methods for PFO will be described, emphasizing the importance of a multidisciplinary approach involving ophthalmologists, cardiologists, neurologists and imaging specialists. In the future, prospective studies and clinical trials are warranted to provide further insights into the preventive role and optimal therapeutic strategies for managing PFO-related ocular complications, ultimately guiding clinical decision making and optimizing patient care.

Histopathology reporting of temporal artery biopsy specimens for giant cell arteritis: results of a modified Delphi study

The temporal artery biopsy (TAB) is regarded as the gold-standard test in the diagnosis of giant cell arteritis (GCA). There is a lack of agreement among experienced pathologists regarding the...

764 Burn Advanced Practice Provider Fluorescein Dye Staining Reduces Ophthalmology Consults

Abstract Introduction Facial burn injury patients typically receive ophthalmology consultations irrespective of the severity of their peri-ocular or ocular involvement. Minor facial burns without significant eye involvement or ocular complaints often do not require in-patient ophthalmologist assessment. We sought to assess ocular fluorescein dye staining by burn unit Advanced Practice Providers (APP; Physician Assistants and Nurse Practitioners) to decrease unnecessary ophthalmology consults. Methods A prospective evaluation was performed at our ABA-verified burn center for all facial burn injury patients admitted between January 1 through August 31, 2023. Patients who presented with full-thickness injuries to their eyelids or peri-ocular area, those exhibiting tense eyelids raising concern for ocular compartment syndrome, those with severe eye pain and anyone with acute vision loss were excluded from staining and received an immediate ophthalmology consult. For patients with facial burns who did not meet the aforementioned criteria, fluorescein dye stains were administered upon admission by APPs, if available. Ophthalmology consults were only ordered for patients with positive stains. Results 83 patients were admitted with facial burns between January 1 and August 31, 2023. Of these, 42 patients received fluorescein dye stains by APPs. Among those stained, 79% were male and 21% female. The average age was 49 years old (range 19 to 82). The average TBSA affected was 8.46% (range 0.1% to 38.5%). The majority of patients (83%) had flame/flash burns, 7% had scald burns, 2% had chemical burns, 2% had sun burns and the remainder had unclear etiology. 34 patient dye stains (80%) yielded negative results, obviating the need for an ophthalmology consult. The remaining 8 had positive results, necessitating a consult. Among these, 4 were false positives with no ocular injury found by ophthalmology. The remaining 4 exhibited ocular chemosis, trace punctate epithelial erosions, thermal keratopathy and chronic central epithelial defects from prior Lasik surgery. Ophthalmology was consulted in 37 out of 83 patients, with only 8 consults resulting from APP staining. This signifies a 48% overall reduction in consults placed during this 8-month time frame, and an 80% reduction of consults in whom qualified for the pathway. Conclusions Fluorescein dye staining by burn unit APPs minimizes unnecessary ophthalmology consults, likely reducing healthcare costs for patients and healthcare facilities. Applicability of Research to Practice Burn centers should consider fluorescein dye stain screening as part of routine practice for burn patients.

Multicenter Study of the Effectiveness of Antifungal Stewardship Team Intervention for Candidemia in Japan in 2008-2021.

Candidemia, linked to high mortality rates, requires prompt antifungal therapy for better outcomes. Treatment is structured as an action bundle, which is beneficial when followed closely. However, the Japanese action bundle lacks detailed guidance on severe complications like endocarditis or ocular issues. To address this, we adjusted the action bundle and assessed outcomes with and without AFT intervention. We strengthened protocols for blood cultures and organ assessments, and the AFT contacted the primary physician when yeast-like fungi were detected in the patient's blood culture bottles. Analyzing 204 candidemia cases from 2008-2021, we observed increased adherence and reduced mortality post-AFT intervention. Ophthalmology consultations rose significantly, but many patients had only one visit, suggesting inadequate follow-up. If endophthalmitis is diagnosed, a change in the treatment approach may be necessary. There is a possibility that abnormal ocular findings will be detected during subsequent visits, which highlights the need for improvement in ophthalmology follow-up rates as a future challenge for our AFT activities.

Ocular Trauma Characterization in a Reference Emergency Eye Centre in Colombia (FOSCAL).

Ocular trauma is one of the most important causes of ocular morbidity and inadequate visual acuity in developed and developing countries. In some countries, eye trauma is the leading cause of monocular blindness. Studies conducted in developing countries like Colombia suggest that there is a lack of awareness of preventive measures. In Colombia, there is no countrywide ocular trauma registry. The purpose of the present study is to describe and analyse characteristics of ocular trauma at a tertiary ophthalmology emergency department in Colombia. Patients who consulted or were referred to the ophthalmologic emergency department of FOSCAL due to eye injuries between March 1, 2022, and January 10, 2023, were included in this cross-sectional study. Of 1 957 patients, 2 088 eyes were included. Men comprised 78.5% of the patients, the median age was 36 years, and 75.0% lived in urban areas. The median latency between trauma and ophthalmology consultation was 21.8 hours. Of the eyes, 1 805 (88.4%) had suffered mechanical or mixed (mechanical plus burn) trauma. Of the injuries, 87.5% were unilateral. In terms of the circumstances, 45.9% of injuries occurred during working or educational activities (in 85.6% of these cases, without eye protection), 28.2% in home accidents, and 14.0% in transportation situations. According to the Birmingham Eye Trauma Terminology System (BETT), 1 735 eyes (91.1%) were closed globe injuries, and 49 eyes (2.7%) were open globe injuries. Fifty eyes (2.8%) could not be categorised according to BETT at the initial consultation and were classified as "still to be determined". In the Ocular Trauma Score (OTS), 85.8% were category 5. Of the ocular burn cases, 93.0% were categorised as grade I according to the Roper Hall classification. In line with global literature, a much higher proportion of men than women sought consultation for ocular trauma. The findings suggest a need for improvement in the referral process from institutions with the lowest level of care. Lack of awareness about eye protection is an issue. Surgical exploration or additional tests may be necessary for precise injury classification. We therefore propose adding a "still to be determined" category to the BETT initial classification. These cases may be reclassified later, thus improving the accuracy of OTS calculation.

RobOCTNet: Robotics and Deep Learning for Referable Posterior Segment Pathology Detection in an Emergency Department Population.

To evaluate the diagnostic performance of a robotically aligned optical coherence tomography (RAOCT) system coupled with a deep learning model in detecting referable posterior segment pathology in OCT images of emergency department patients. A deep learning model, RobOCTNet, was trained and internally tested to classify OCT images as referable versus non-referable for ophthalmology consultation. For external testing, emergency department patients with signs or symptoms warranting evaluation of the posterior segment were imaged with RAOCT. RobOCTNet was used to classify the images. Model performance was evaluated against a reference standard based on clinical diagnosis and retina specialist OCT review. We included 90,250 OCT images for training and 1489 images for internal testing. RobOCTNet achieved an area under the curve (AUC) of 1.00 (95% confidence interval [CI], 0.99-1.00) for detection of referable posterior segment pathology in the internal test set. For external testing, RAOCT was used to image 72 eyes of 38 emergency department patients. In this set, RobOCTNet had an AUC of 0.91 (95% CI, 0.82-0.97), a sensitivity of 95% (95% CI, 87%-100%), and a specificity of 76% (95% CI, 62%-91%). The model's performance was comparable to two human experts' performance. A robotically aligned OCT coupled with a deep learning model demonstrated high diagnostic performance in detecting referable posterior segment pathology in a cohort of emergency department patients. Robotically aligned OCT coupled with a deep learning model may have the potential to improve emergency department patient triage for ophthalmology referral.

Localized scleroderma

Localized scleroderma (LS), also called circumscribed scleroderma or morphea, comprises aheterogeneous group of diseases that can be classified into four subtypes: limited, linear, generalized, and mixed LS. All manifestations are primarily due to chronic progressive fibrosis of the skin or structures close to the skin. Involvement of internal organs or the transition to systemic sclerosis is excluded by definition. Adistinction is made between forms that primarily affect the skin (up to the dermis) or that severely involve subcutaneous fat tissue, muscle fascia or muscles. Adetailed examination is required for clinical diagnosis. In order to improve comparability of findings, photo documentation and the use of clinical scores should be carried out. For superficial subtypes the use of topical glucocorticosteroids, calcineurin inhibitors or phototherapy is initially recommended, whereas for severe forms with deep involvement or overall therapy refractoriness, the diagnosis should first be expanded and systemic therapy initiated at an early stage. Especially, in cross joint or extremity-dominant forms of linear LS or in cases with head and neck involvement, such as en coup de sabre, Parry-Romberg syndrome and other subtypes with aprominent musculoskeletal affection, an MRI examination should be arranged. Depending on location, an ophthalmological, neurological, orthodontic, rheumatological or orthopedic consultation may be necessary. For systemic therapy, methotrexate alone or in combination with systemic glucocorticosteroids as pulse therapy is recommended as first-line treatment.

Multimodal Imaging of Choroidal Nodules in Neurofibromatosis Type I.

To clarify the possibilities and role of posterior segment imaging in patients with neurofibromatosis type I (NF1), and to show the prevalence of this disease in the pediatric population in Slovakia. Until recently, ophthalmologic consultations in patients with NF1 were limited mainly to the observation of Lisch nodules of the iris and the presence of optic nerve glioma. However, advances in imaging capabilities have made it possible to investigate and describe new f indings concerning the ocular manifestations of this disease. Between October 2020 and November 2021, we examined the anterior and posterior segment of 76 eyes (38 children – 12 boys and 26 girls) with genetically confirmed NF1 gene mutation at our clinic. The age of the patients ranged from 4 to 18 years. The anterior segment was checked for the presence of Lisch nodules biomicroscopically with a slit lamp. On the posterior segment, the presence of choroidal nodules was checked by various imaging methods – fundus camera, infrared confocal selective laser ophthalmoscopy, MultiColor imaging, OCT, and OCT angiography. All the patients had magnetic resonance imaging performed in order to detect potential optic nerve gliomas for the purpose of diagnosis. We observed the correlation between the patients’ age, presence of Lisch nodules and the presence of choroidal nodules. Eight patients also had other manifestations of the disease – optic nerve gliomas or microvascular changes (so-called “corkscrew” vessels). Out of 38 patients, Lisch iris nodules were present in 20 patients (53%) and choroidal nodules in 24 patients (63%). There was no positive correlation between the presence of these two manifestations within the same patient or eye, but there is a clear correlation between the presence of choroidal nodules and patient age. The results suggest that a previously unknown ocular manifestation of neurofibromatosis type I, namely choroidal nodules, has a higher prevalence than Lisch nodules also in the pediatric population and can be easily visualized using various imaging modalities. It will be important to include follow-up observation of this finding among the standard controls for ocular findings in NF1, and it will be very interesting to correlate this f inding with the exact NF1 mutation

A Remote Consult Retinal Artery Occlusion Diagnostic Protocol

To report a novel protocol for diagnosis of retinal artery occlusions at the point of care using OCT and a remote consult model. Retrospective case series and evaluation of a diagnostic test or technology. Adult patients who presented with painless monocular vision loss and were diagnosed with a nonarteritic retinal artery occlusion. OCT machines were placed in the stroke center or emergency department at 3 hospitals within our health system. Patients who presented with painless monocular vision loss were evaluated by the stroke neurology service and an OCT was acquired. The images were interpreted remotely by the retina service. An in-house ophthalmology consult was not required to make the final treatment decision. Eligible patients were treated with intra-arterial tissue plasminogen activator (IA-tPA). Patients were followed by ophthalmology during their admission when an in-house consultation service was available or otherwise evaluated immediately after discharge. Visual acuity (VA) before and after treatment with IA-tPA; time from last known well (LKW) to treatment; and time from presentation to treatment. In the first 18 months since the protocol went live, 59 patients were evaluated. Twenty-five patients (42%) had a confirmed retinal artery occlusion based on OCT and follow-up examination. Ten patients were eligible for treatment, and 9 patients received treatment with IA-tPA. There was a statistically significant improvement in mean VA from logarithm of the minimum angle of resolution (logMAR) 2.14 to logMAR 0.7 within 24 hours after treatment (P= 0.0001) and logMAR 1.04 after 4 weeks (P= 0.01). Clinically significant improvement was noted in 66% of patients within 24 hours and maintained through 1 month in 56% of all treated patients. The mean time to treatment from LKW was 543 minutes and from presentation at the stroke center was 146 minutes. We report the successful implementation of a remote consult protocol using point-of-care automated OCT. This novel paradigm demonstrates the potential utility of remote consult services for the diagnosis of time-sensitive ophthalmic emergencies. Proprietary or commercial disclosure may be found after the references.

Validity and Reliability of Farra Eye Model as a Surgical Simulator for Capsulorhexis Training

Abstract&#x0D; Introduction &amp; Objectives : Various simulation models are available for cataract surgery training. Farra Eye Model, a new cataract surgery simulator, was developed to provide the resident with more affordable options. This study aims to determine the validity and reliability of the Farra Eye Model as a surgical simulator for capsulorhexis training.&#x0D; Methods : A cross-sectional pilot study was performed among ophthalmology residents and consultants to assess face, content, and construct validity of a new surgical simulator. Subjects were divided into novice, intermediate, and expert groups according to their level of expertise. Face and content validity was assessed using a validated questionnaire with a 5-point Likert scale response. Construct validity was done by comparing capsulorhexis performance between the three groups. Two raters assessed performance using capsulorhexis indices in ICO-OSCAR: Phaco assessment tool, number of forceps grabs, and duration of capsulorhexis.&#x0D; Results : A total of 33 subjects were recruited and divided equally into three groups. The overall face validity score was favorable (3.67 ± 0.67). However, the capsule elasticity was rated poor (2.73 ± 1.1) among the intermediate group. The content validity was favorable regarding the overall score (4.15± 0.58) and each assessment component. In the construct validity test, intermediate and expert groups showed better capsulorhexis performance than the novice group on all parameters (p&lt;0.001), with good inter-rater reliability (ICC&gt;0.7).&#x0D; Conclusion : Farra Eye Model has a good face and content validity for capsulorhexis training and is able to differentiate the novice group from intermediate and expert groups. However, it remains a challenge to replicate human lens capsule elasticity.