Ophthalmologic Consultation Research Articles

Knowledge about age-related eye diseases in the general population in Germany

BackgroundWith a rising prevalence of age-related eye diseases, prevention and early diagnosis of these conditions are key goals of public eye health. Disease-related knowledge in the general public supports these goals but there is little data available. Thus, we have assessed knowledge of cataract, glaucoma, age-related macular degeneration (AMD) and diabetic eye disease in the German adult general population in a cross-sectional study and identified target groups for health education interventions.MethodsKnowledge assessment content was identified based on a literature review, expert input, and a list of items was generated after a qualitative selection process. The resulting 16-item instrument (4 items per condition) was administered to 1,008 participants from a survey panel, demographically representative of the adult German population. Test properties were evaluated based on a Rasch model and multiple correspondence analysis (MCA). Binary-logistic regression analysis was performed to investigate associations with age, sex, education level, employment status, marital status, income, reported health status, visual difficulties, and recent general practitioner (GP) and ophthalmologist consultations.ResultsReplies were correct for a median of 9 out of 16 (range 2 – 16) items, which differed between conditions (p < 0.0001). Most responses were correct for cataract items (median: 3 / 4) and least were correct for AMD items (median: 2 / 4). 27%, 9%, 1% and 19% of respondents replied correctly to all cataract, glaucoma, AMD and diabetic eye disease-related items, respectively. Rasch analysis suggested an adequate targeting of items and in MCA, no evidence of multidimensionality was present. Older age, being retired, decreased general health and recent GP or ophthalmology consultations were significantly associated with more knowledge about common eye conditions (p ≤ 0.005). GP or ophthalmology consultations remained significant in a multivariable model (p ≤ 0.011).ConclusionsKnowledge gaps regarding eye health are considerable in the German general population and should therefore be addressed in educational interventions targeting the public. Special attention when designing such campaigns needs to be paid to infrequent users of the healthcare system. Knowledge of AMD seems to be poorer compared to other eye conditions.

Simplified practice for ophthalmologist consultation in malar fractures: A retrospective study

Zygomatic bone contributes to the orbital walls, and therefore associated injuries carry a high risk of severe dysfunction of the visual apparatus. The aim of our study was to retrospectively assess the spectrum and frequency of ophthalmic involvement in patients presenting with malar fracture, and the need for referral to an ophthalmologist for evaluation.In total, 102 patients presenting with malar fracture between January 2008 and August 2017 at Bapuji Dental College and Hospital, Davangere, Karnataka were enrolled in this study. Patients with confirmed malar fracture were categorized according to Henderson's classification, and associated ocular injuries were recorded. Assessment of the spectrum and frequency of ophthalmic involvement in patients presenting with different types of malar fracture was then carried out, followed by categorization of the need for referral to the ophthalmologist with regard to the associated ocular injury, as per the Al-Qurainy et al. (1991) scoring system, allocating the patients to early, routine, and non-referral categories.Statistically significant differences in proportions of various types of ophthalmic involvement were found between categories of malar fracture, and in degrees of ophthalmic involvement within each category of malar fracture, except in the Type II group of patients. The most severe ocular injuries were noted in Type VII followed by Type V, with the least severe injuries noted in Type II patients. According to the Al-Qurainy et al. (1991) scoring system, eight patients required early referral, 10 patients needed routine referral, and 84 patients were in the non-referral category.Categorization of referral of patients to an ophthalmologist in hospitals lacking ophthalmology departments can be based on the Al-Qurainy et al. classification of referral for Henderson's Type III, IV, and VI. Henderson's Type I and II patients need to be referred only in medicolegal cases. Henderson's Type VII and V patients require mandatory referral.

Meibomian gland dropout of upper eyelids as a novel biomarker for early diagnosis of primary Sjögren's syndrome: a pilot study.

Early diagnosis of primary Sjögren's syndrome (pSS) remains difficult due to its insidious onset. To identify whether meibomian gland dropout (MGD) is a sensitive and noninvasive predictor of pSS by studying its association with histopathology in labial salivary gland biopsy in patients with clinically suspected pSS. Prospective, randomized, multicenter, comparative effectiveness study. The study was conducted from July 2022 to July 2023. In all, 56 eligible participants with clinically suspected pSS were recruited from three combined ophthalmology medicine/rheumatology SS clinics. All participants with suspected pSS were evaluated and diagnosed by ophthalmology and rheumatology consultants and underwent infrared imaging of the meibomian glands using Keratograph 5M and histopathological evaluation of labial salivary gland biopsies. The length, width, and tortuosity of the meibomian glands were measured; the dropout rate in the nasal, temporal, and total eyelids was analyzed; and the dropout score was calculated using meibography grading scales. Among the 56 participants, 34 were identified with pSS, and 22 were diagnosed with non-SS dry eye (NSSDE) and served as the control group. We recorded significant differences in the temporal and total MGD rates of the upper eyelids between the pSS and NSSDE groups (all p < 0.01). Improved prediction accuracy was achieved with the temporal and total MGD rates in the upper eyelids, with area under the curve values of 0.94 and 0.91, and optimal cutoff points of 0.78 and 0.75, respectively. MGD in the upper eyelids, especially in the temporal portion, is strongly associated with the histopathological outcome of labial salivary gland biopsy in pSS and is proposed as a highly predictive and noninvasive biomarker for the early diagnosis of pSS. ClinicalTrials.gov identifier: ChiCTR2000038911.

Diabetic Macular Edema Optical Coherence Tomography Biomarkers Detected with EfficientNetV2B1 and ConvNeXt.

(1) Background: Diabetes mellitus (DM) is a growing challenge, both for patients and physicians, in order to control the impact on health and prevent complications. Millions of patients with diabetes require medical attention, which generates problems regarding the limited time for screening but also addressability difficulties for consultation and management. As a result, screening programs for vision-threatening complications due to DM have to be more efficient in the future in order to cope with such a great healthcare burden. Diabetic macular edema (DME) is a severe complication of DM that can be prevented if it is timely screened with the help of optical coherence tomography (OCT) devices. Newly developing state-of-the-art artificial intelligence (AI) algorithms can assist physicians in analyzing large datasets and flag potential risks. By using AI algorithms in order to process OCT images of large populations, the screening capacity and speed can be increased so that patients can be timely treated. This quick response gives the physicians a chance to intervene and prevent disability. (2) Methods: This study evaluated ConvNeXt and EfficientNet architectures in correctly identifying DME patterns on real-life OCT images for screening purposes. (3) Results: Firstly, we obtained models that differentiate between diabetic retinopathy (DR) and healthy scans with an accuracy of 0.98. Secondly, we obtained a model that can indicate the presence of edema, detachment of the subfoveolar neurosensory retina, and hyperreflective foci (HF) without using pixel level annotation. Lastly, we analyzed the extent to which the pretrained weights on natural images "understand" OCT scans. (4) Conclusions: Pretrained networks such as ConvNeXt or EfficientNet correctly identify features relevant to the differentiation between healthy retinas and DR, even though they were pretrained on natural images. Another important aspect of our research is that the differentiation between biomarkers and their localization can be obtained even without pixel-level annotation. The "three biomarkers model" is able to identify obvious subfoveal neurosensory detachments, retinal edema, and hyperreflective foci, as well as very small subfoveal detachments. In conclusion, our study points out the possible usefulness of AI-assisted diagnosis of DME for lowering healthcare costs, increasing the quality of life of patients with diabetes, and reducing the waiting time until an appropriate ophthalmological consultation and treatment can be performed.

Evaluation of a Novel Method for the Assessment of Ocular Adverse Events and Associated Functional Impact in Transplant Ineligible Patients with Newly Diagnosed Multiple Myeloma Treated with Belantamab Mafodotin, Lenalidomide, and Dexamethasone in the Phase 1/2 Belard Trial

Introduction Belantamab mafodotin (belamaf; GSK2857916), an antibody-drug conjugate targeting B-cell maturation antigen, has shown promising efficacy and a favorable tolerability profile in the treatment of multiple myeloma. Ocular adverse events (OAEs), manifesting as visual acuity changes, ocular symptoms, and corneal findings, are common with belamaf and the main reason for dose modifications (dose reduction, dose holds) or treatment discontinuation. Keratopathy and Visual Acuity (KVA) scale was used in most belamaf trials, including the pivotal DREAMM-2, to guide belamaf dose modifications. KVA grading is dependent on an ophthalmologist consultation prior to belamaf administration. Herein, we evaluate a novel approach to guide belamaf dosing in transplant ineligible (TI) patients (pts) with newly diagnosed multiple myeloma (NDMM), treated with an extended dosing schedule of belamaf in combination with lenalidomide and dexamethasone (Rd) in the phase 1/2 BelaRd study. Methods BelaRd (NCT04808037) is an open-label, phase 1/2 study conducted in Greece, aiming to enroll 66 TI NDMM pts. Part 1 evaluated the safety/tolerability of three belamaf doses (2.5/1.9/1.4 mg/kg) plus Rd in 36 pts and established that the recommended phase 2 dose (RP2D) is 1.9 mg/kg, initially administered q8w and, depending on toxicity, adjusted to q12w. Part 2 investigates the safety/efficacy of RP2D in Groups A and B, comprised of 15 pts each, and evaluates two different sets of guidelines for the management of OAEs. In Group A, belamaf dosing is guided by the KVA scale; in Group B, dose modifications are determined by the pts' responses on ocular symptoms and their impact on activities of daily living (ADL), captured by the Vision Related Anamnestic (VRA) tool, and by the presence of ≥Grade (Gr) 3 KVA events (BCVA reduced/corneal findings). VRA is a novel, 9-item physician administered questionnaire designed to assess the frequency of ocular symptoms and their impact on vision-related activities. Ocular exams include Snellen best corrected visual acuity (BCVA) and slit lamp corneal evaluation, while ocular symptoms are classified by CTCAE v5.0. Herein, we present the OAEs and the clinical activity of the treatment combination for both Groups of Part 2 (cut-off date 05/06/2023). Results By the cut-off date, twenty-four pts [median age: 75.5 years; male: 16 (66.7%)] had received ≥ 1 belamaf dose in Part 2 and were still on treatment. At baseline, most pts had ocular comorbidities. The median belamaf administrations and number of cycles reached were 3.0/2.0 and 6.5/5.5, for Groups A and B, respectively. A meaningful BCVA decline (BCVA &amp;lt;20/50) with at least 3 lines drop in the better seeing eye, was noted in 5/52 (9.6%) and 5/45 (11.1%) assessments, while BCVA ≤20/200 with at least 3 lines drop was noted in 1/59 (1.7%) and 2/51 (3.9%), respectively. Overall, no ≥Gr 3 ocular symptoms were observed, while the most frequent ≥Gr 2 ocular symptom was dry eye (57/110, 51.8%); also, no ≥Gr3 keratopathies were recorded. Among 66/59 VRA assessments, ocular symptoms and ADL impairment, manifesting for &amp;gt;50% of the time (substantial time) in the last 24 hours prior to belamaf administration, were noted in 2 (3.0%)/9 (15.3%) and 2 (3.0%)/7 (11.9%), respectively. Importantly, numerically similar proportions of KVA events and skipped belamaf doses were noted in both Groups (Table 1). Furthermore, although the sample size of the present analysis does not allow conclusions for the VRA test characteristics, it is notable that in all assessments where eyesight difficulties were reported for substantial time, ≥Gr2 KVA events were also recorded, suggesting a potential association between VRA responses and KVA events, that warrants further investigation. Finally, in terms of clinical activity, for the 19 response-evaluable pts (≥2 efficacy assessments), at a median follow-up of 7.4 months the ORR was 90%/100% in Groups A and B (PR/VGPR: 30%/60%; 66.7%/33.3%) with no disease progression observed. Conclusions In this preliminary descriptive analysis, the VRA tool was safe and effective in informing belamaf dose adjustments in the extended dosing schedule. Recruitment in Part 2 is ongoing and, as data accumulates, future analyses will provide further insight on the potential association of the VRA tool with KVA events, which may eliminate the need for an ophthalmic exam prior to belamaf dosing.

Ophthalmic diseases in meningitis within the pediatric population

ObjectifLa méningite peut se solder par des complications ophtalmiques chez les enfants. Or, ces retombées visuelles ont été peu étudiées dans les pays industrialisés. La présente étude a pour objectif de mettre au jour les séquelles oculaires et neuro-ophtalmiques éventuelles de la méningite au sein d'une population pédiatrique dans un hôpital de soins tertiaires pour enfants. NatureOn a réalisé un examen rétrospectif des dossiers de tous les enfants qui ont reçu un diagnostic de méningite entre 2006 et 2015 à l'Hôpital de Montréal pour enfants. L’étude a reçu l'approbation du comité d’éthique du Centre universitaire de santé McGill et respectait les principes de la Déclaration d'Helsinki. MéthodesAprès extraction des dossiers médicaux des enfants qui ont eu une méningite, on a retenu les patients qui ont fait l'objet d'une consultation en ophtalmologie. Les données démographiques et les antécédents médicaux pertinents, de même que les résultats des examens oculaires et de l'imagerie, ont été notés. La proportion d'anomalies oculaires a été calculée et analysée. RésultatsAinsi, 72 des 861 patients (8,4 %) qui ont eu une méningite ont fait l'objet d'une consultation en ophtalmologie, dont 46 qui répondaient aux critères d'inclusion; de ce nombre, 31 patients (67,4 %) présentaient des anomalies oculaires, qui touchaient le plus fréquemment l'acuité visuelle (8 patients sur 32), les mouvements extraoculaires et l'alignement (14 patients sur 28), le nerf optique (10 patients sur 41), la réactivité pupillaire (4 patients sur 35) et la cellulite périorbitaire/orbitaire (4 patients sur 46). Les enfants plus âgés étaient plus susceptibles de présenter des anomalies ophtalmologiques. ConclusionNotre étude met en relief les anomalies oculaires découvertes chez des enfants qui ont eu la méningite et qui ont été soignés dans un centre de soins tertiaires dans un pays à indice de développement sociodémographique élevé. Les complications risquent de perdurer. Les ophtalmologistes traitants doivent être bien au fait du risque d'anomalies oculaires associées à la méningite, ce qui nous amène à recommander que les professionnels de la santé soient mieux sensibilisés à cette éventualité.

Assessing an Exposure Keratopathy Prevention Strategy in Mechanically Ventilated Patients: A Retrospective Study.

Patients who are intubated and sedated are at risk for developing exposure keratopathy, which can lead to permanent vision loss. This retrospective study assesses the incidence of exposure keratopathy (EK) in intensive care unit (ICU) patients before and after implementation of an EK Prevention Order Set. At one tertiary care hospital (Bronx, NY), an "Exposure Keratopathy Prevention Order Set" was implemented to ameliorate this risk which included the application of white petrolatum-mineral oil lubricating ointment every 6 hours in both eyes. This retrospective chart review study analyzed the incidence of EK diagnosis before and after implementation of this EK Prevention Order Set. Patients who were on mechanical ventilation at the time of ophthalmology consult request between January 1, 2021, and December 31, 2021, were included. Ophthalmology consult notes of patients with EK diagnosis were reviewed for details regarding the consult request, examination findings, diagnosis, and treatment plan. There were 247 and 361 ventilated ICU patients before and after the order set, respectively. The number of ophthalmology consults decreased slightly after the order set from 15 of 247 to 20 of 361 ventilated patients. In addition, the rate of EK among ventilated patients decreased from 4.5% (11 of 247 patients over 151 days) to 2.2% (8 of 361 patients over 212 days; P =0.154) with a risk ratio of 0.50 (95% CI 0.20-1.22). The number of patients diagnosed with EK trended down after implementation of the EK Prevention Order Set.

A role of point-of-care ultrasound in the emergency department diagnosis of vision loss due to traumatic cataract

BackgroundOcular complaints, including acute or subacute vision loss, are commonly encountered in emergency departments (ED). These potentially time-sensitive complaints are difficult to diagnose and evaluate without adequate, specialized equipment and expertise. Additionally, a thorough evaluation often requires a more extensive and specialized physical exam, imaging, and ophthalmologic consultation, all of which may not be readily available in the acute setting.Case presentationThis case report presented a patient in the emergency department with the chief complaint of vision loss. Point-of-care ultrasound (POCUS) using the 10-MHz-linear-array probe, in the ocular setting, demonstrated calcification of the lens, a finding consistent with cataract in the right eye.ConclusionsThe use of POCUS can expedite the accurate identification of vision threatening pathology, such as cataracts, and streamline ED disposition and plan of care.

Abstract 084: Intracranial Onyx Resolute Stenting In Idiopathic Intracranial Hypertension Patient With Pre‐existing Nickel Allergy: Case Report

Introduction Idiopathic intracranial hypertension (IIH) is a pathology involving an increase in intracranial pressure leading to symptoms including papilledema, tinnitus, and elevated cerebrospinal fluid opening pressure. Recent research has identified venous sinus stenosis as a cause of IIH, a common treatment of which is venous stenting and angioplasty. An adverse event of this procedure is in‐stent stenosis (ISS), due to either neointimal hyperplasia or hypersensitivity to an element in the stent. There has been speculation regarding whether nickel in intracranial stents is a cause of concern, due to its potential to cause a Type IV hypersensitivity reaction and ISS, which is an indicator of future stroke. The purpose of this case report is to determine if the cobalt‐based alloy Onyx Resolute intracranial stents can safely treat IIH in patients with allergic contact dermatitis to nickel. Methods We present a 38‐year old woman who presented with migraines and IIH with papilledema and severe pulsatile tinnitus. Headaches had been present for 5‐10 years. Ophthalmology consult revealed bilateral papilledema, upon which an MRI and MRV revealed venous stenosis. There was a 17mmHg pressure gradient measured in the patient. Patient could not tolerate acetazolamide, with kidney stones and loss of sheen in hair. Cerebral angiogram indicated right transverse‐sigmoid junction stenosis and atretic left venous sinus. The patient had an Onyx Resolute stent placed in the right transverse sigmoid junction. The Onyx Resolute stent is a Zotarolimus‐eluting stent made up of a cobalt‐based shell and a platinum‐Iridium core and is not recommended for patients with a hypersensitivity to nickel, cobalt, or chromium, but has a lower nickel content than a self‐expanding stent. Results Patient underwent cerebral angiogram, revealing right transverse‐sigmoid junction stenosis with a 17mmHg pressure gradient. Stenting and angioplasty were performed; this reduced the venous sinus pressure in the R transverse sinus (pre‐stenotic segment) from 43 mm Hg to 24 mm Hg with resolution of the R transverse‐sigmoid junction pressure gradient. Patient was treated with prasugrel (Effient) for one month. At the one‐month follow‐up, the patient reported an improvement of symptoms, with near‐resolution of her prior headaches in terms of severity and frequency following her procedure. Visual acuity is at baseline, pending formal follow‐up assessment for papilledema. Follow‐up CT Head Venogram with and without contrast showed a patent R transverse to sigmoid venous stent. The patient was continued on aspirin 81mg daily and prasugrel 5mg daily and is to continue follow‐up with yearly ophthalmologic exams. Conclusion Although there is speculation regarding the use of metal intracranial stents in patients allergic to nickel, our patient has shown that it is safe to use the Onyx Resolute intracranial stent despite a pre‐existing nickel hypersensitivity.

Dolor ocular. Estrategias diagnósticas, tratamiento y manejo en urgencias

Eye pain is defined as pain in the eye itself, the orbit, or neighboring structures. It is one of the main reasons for emergency ophthalmologic consultations. Not all eye pain has its origin in the eyeball; indeed, these symptoms may be due to disease in the orbit or a neighboring structure. All patients who consult due to eye pain should have a full case history performed that is aimed at defining the pain's characteristics (manner of onset, intensity, location, radiation, circumstances that aggravate or attenuate it). Subsequently, a full ophthalmologic examination that includes visual acuity, an intrinsic and extrinsic ocular motility examination, examination of the anterior segment and ocular adnexa using a slit lamp, intraocular pressure, and an assessment of the eye fundus must be performed. The treatment of eye pain is mainly aimed at treating the underlying etiopathogenic mechanism, although many drugs allow for improving symptoms, such as oral analgesics or topical cycloplegic drugs.

Evaluation of the knowledge and practice of family physicians in the management of diabetes mellitus type 2 in Iran

BackgroundThe increasing prevalence and occurrence of type 2 diabetes has made it a widespread epidemic. Being the first line of care, family doctors can play an essential role in this field. The knowledge of these doctors about how to deal with the prevention, diagnosis, and correct treatment of patients is fundamental in reducing the burden of this disease in the community. In this study, we decided to evaluate the knowledge and practice of family doctors in Shiraz-Iran and its related factors in managing Diabetes.MethodThis analytical cross-sectional study was conducted among family doctors of two primary healthcare centers, Shahadai Wal-Fajr Health Center and the Enghlab Health Center in Shiraz, Iran, from March 2021 to August 2021. A researcher-designed diabetes questionnaire consisting of 21 items and a data collection form including demographic information and other related factors was used in this study. An interviewer asked the questions from participants at their workplace and completed the questionnaires. The data were analyzed by SPSS-20 software. A linear regression test was used to investigate the factors affecting the questionnaire score. A one-way ANOVA test was used to compare questionnaire scores among multiple groups.ResultsOn average, the participants obtained 62.5% of the total score. The average scores for each question in the screening, the diagnosis, and the treatment sections were 0.5 ± 0.28, 0.65 ± 0.2, and 0.66 ± 0.17, respectively. Physicians’ knowledge about the blood sugar threshold for diagnosing Diabetes was suboptimal, and 81.9, 47, 43 correctly mentioned the FBS, 2hrpp BS, and HbA1c threshold, respectively. Although 95% knew the first line medication but 33.6% prescribed 2nd or 3rd medication for DM treatment. Only 43% knew the goal of therapy. Sixty-three doctors (42%) have not registered any referrals for newly diagnosed uncomplicated diabetic patients, and 37.6% referred these new DM cases to an internist or endocrinologist at the first visit. Microvascular complication screening, such as testing for microalbuminuria and ophthalmologist consultation reported by 32. 89% and 8% of physicians, respectively. Years since graduation was the determining factor of the knowledge level of doctors in this study. Regarding the preferred education method, most participants selected the workshop method as the preferred training method. Virtual education was ranked as the second preferred educational method.ConclusionThe knowledge and practice of general family doctors were lower than the optimal level in diabetes screening, diagnosis, and treatment. In the treatment of patients, the knowledge of most of the physicians was appropriate in the early stages of treatment, such as determining the time to start the medication and the first line of treatment, but in the follow-up and more advanced treatment, the knowledge and performance of the doctors were less than expected. They prefer to refer patients to higher levels in the healthcare system. Recently graduated physicians had better knowledge and approach to DM management. Therefore, effective periodic training should be conducted as soon as possible to address this pitfall and improve the quality of care. Workshops and virtual education were the most preferred education methods from the participants’ points of view. So, it is suggested that these methods be used as the first training methods. Implementing the specialty training program for family medicine (which has been started in our country for a few years) is the best final solution. In addition, A clinical guideline should be designed for family physicians highlighting these physicians’ roles in the management of Diabetes.

Eye &amp; Diabetes in Morocco: Where are we from the global screening guidelines?

Abstract In Morocco, the prevalence of diabetes in the adult population is 12.4% (WHO). Diabetic Retinopathy (DR) is the 2nd cause of blindness. Nearly 1 million people worldwide are blind due to diabetes. The aim of our work is to study the epidemiological profile of patients with diabetes in ophthalmology and to determine the observance of the follow-up guidelines. This is a descriptive study carried out at the Vision Clinic of Tetouan-Morocco, including all diabetic patients who presented to the ophthalmology consultation of the same doctor, between June 2022 and December 2022. The study involved 500 patients, including 217 men and 283 women, with an average age of 62 years. The average duration of diabetes was 11.5 years. 1 out of 3 diabetic patients was unaware that diabetes was a blinding disease and 3 out of 4 patients did not follow a specific diet. 1 out of 8 patients has an annual ophthalmological check-up. 55% of the patients have a screening every 2-5 years, when 7% haven't had their eyes checked in the last 10 years. Visual complaints accounted for 58% of the motivations for all consultations, while diabetes only accounted for 30%. Depending on the duration of the condition, diabetes represents 60% of the reasons for consultation among new diabetics (1 year) whereas it represents only 20% among diabetics over 10 years old. Eye examinations revealed a proliferative DR in 24% of the cases and a non proliferative DR in 22%. In 31%, there was no sign of DR and in 23%, the fundus was inaccessible due to cataract. The prevalence of proliferative DR increases with years of diabetes, reaching 40% in diabetics over 20 years old. The results of this work prove that diabetes is still underestimated by the Moroccan population. This is probably related to a lack of information of the target population. Thus, health professionals should strengthen their education in order to establish a better monitoring and screening policy aimed to reduce the occurrence of an avoidable blindness. Key messages • Less than one Diabetic out of 3 consults an ophthalmologist for their diabetes &amp; Only one diabetic out of 8 consults annually in ophthalmology. • The older the diabetes, the less regular is the consultation in ophthalmology &amp; One out of 4 diabetics will already have proliferative diabetic retinopathy at their ophthalmological consultation.

Demographic and socioeconomic disparities in receipt of ophthalmology consultation for facial trauma

ObjectiveFunctional outcomes following facial and ocular trauma are time-sensitive and require prompt evaluation to minimise long-term vision loss, yet few studies have systematically evaluated disparities in the management of these...

Effect of Heating, Ventilation, and Air Conditioning (HVAC) System on Indoor Air Quality in a Medical Facility

Indoor Air Quality (IAQ) refers to the stationary air within an inhabited or occupied structure. Previously, there were fewer studies on indoor air quality in medical facilities in Malaysia especially in Terengganu. Most indoor air quality issues are caused by insufficient Heating, Ventilation, and Air Conditioning (HVAC) systems, which regulate three parameters. The purpose of this study is to assess the indoor air quality of a medical facility and determine if it complies with the Industry Code of Practice 2010 (ICOP 2010) and ASHRAE 170-2017. In this investigation, a total of 3 locations namely Administration Office, Surgical Outpatient Department (SOPD) waiting area and Ophthalmology Consultation Room in Hospital Sultanah Nur Zahirah (HSNZ) were evaluated. Walkthrough inspections were done at the locations before data collection to determine the IAQ. Two IAQ meters, notably VelociCalc and Testo, were used to collect data to assess the temperature, relative humidity, and air flow of the selected locations. Samples were taken every 2 hours for each location from 8 a.m. to 5 p.m. The data then were analysed. All three locations' temperatures were lower than ICOP 2010's acceptable limit (23-26°C), but still within ASHRAE 170-207's 21-24°C range, except for the SOPD waiting room. All three locations met ICOP 2010 and ASHRAE 170-207 relative humidity standards. Meanwhile, only the SOPD waiting room had an appropriate air flow of 0.16-0.17m/s per ICOP 2010. The study also revealed that there was a correlation between the number of occupancies and the performance of HVAC system with the indoor air quality level.

Diabetic Mononeuritis: Isolated Extrinsic Paralysis of the III

Oculomotor paralysis is a rare complication of diabetes. It is a rare form of diabetic neuropathy, with a prevalence of 1 to 14% in diabetics. This is a 52-year-old patient with no known personal history, who presented himself in ophthalmological consultation for left ocular pain and fall of the upper left eyelid, occurred 6 days ago and rapidly progressive in an atraumatic context. Objective ophthalmological examination a moderate left ptosis, with incomplete ophthalmoplegia sparing abduction and twists, without vicious attitude. Visual acuity at a distance without correction was 6/10 in both eyes, P3. At bio microscopy, RPM kept bilaterally, without surface disturbance with normal anterior and posterior segments. This was an incomplete paralysis of the extrinsic component of the III. Emergency radiological checkup ruled out a central vascular and neurological cause. The etiological biological assessment finds fasting blood glucose high at 1.92 g/l. It is sent to the diabetologist for investigations. The degenerative assessment is normal but with a glycated hemoglobin at 10.5%, testifying to an unknown diabetic. It is retained the diagnosis of a paralysis of III incomplete inaugural type 2 diabetes. The evolution after 2 months was marked by the progressive regression of its paralysis after glycemic balance and correction of risk factors. Oculomotor paralysis is not uncommon during diabetes, it is necessary to think about it during etiological assessment for early and adapted management.

Management of Neovascular Age-Related Macular Degeneration Treatment in France from 2008-2018: The Nationwide LANDSCAPE Study.

The aim of this study was to describe the management of neovascular age-related macular degeneration (nAMD) in French patients between 2008 and 2018. This was a retrospective longitudinal cohort study using exhaustive nationwide health records from the French National Health Information database. Enrollment criteria were adults aged ≥ 50 years, nAMD diagnosis, or reimbursement for nAMD treatments (anti-vascular epithelial growth factor [VEGF] injection or dynamic phototherapy with verteporfin). Exclusion criteria were high myopia, diagnosis of other retinal diseases, and treatments for other macular diseases (dexamethasone implant, laser). Main outcome measures were consumption of medical care and nAMD treatments per calendar year and number of years of follow-up. Between 2008 and 2018, we identified 342,961 patients who have been treated for nAMD. Median duration of ophthalmological follow-up exceeded 7years (90months). The median annual number of ophthalmology consultations decreased from nine visits in year 1 after treatment initiation to four visits from year 7 onwards. The median duration of nAMD treatment was 10.1months for all patients, with 48.5% of patients undergoing treatment for < 1year. Only 24.4% of patients had maintained treatment at year 11. Patients remaining under treatment had a median of four anti-VEGF treatments per year throughout the 10-year study period. Ranibizumab was the more common first-line treatment (67.5% of patients) compared to aflibercept (32.4%). About 20% of patients who initiated treatment switched treatment at least once. LANDSCAPE provides exhaustive nationwide data on the real-world management of nAMD in France over a 10-year period. Further investigation into short treatment duration is required, especially in terms of understanding its relation to visual outcomes.

Factors associated with delayed first ophthalmological consultation for primary glaucoma: a qualitative interview study.

Glaucoma has an insidious onset with non-specific early symptoms, often leading patients to delay in seeking help. However, postponing the first ophthalmological consultation can result in delayed diagnosis and treatment, with adverse effects on vision. This study explored the factors associated with delayed first ophthalmological consultation in patients with primary glaucoma, with the overarching aim of informing measures to reduce delayed consultation and avoid the consequent adverse outcomes. We adopted a phenomenological approach. Semi-structured interviews were conducted with patients admitted to a tertiary eye hospital in Tianjin, China, from January 2021 to April 2021. Data were analyzed by Colaizzi's seven-step method. We identified 46 patients with primary glaucoma who delayed their first ophthalmological consultation for various reasons. There were four major themes and 16 sub-themes. The major themes were as follows: (1) occult symptoms that are difficult to identify; (2) insufficient knowledge and understanding of glaucoma-related risks and harm; (3) perceived difficulties in accessing medical care; and (4) inadequate support system. In order to avoid patient delay and consequent irreversible damage to the visual field in patients with primary glaucoma, it is essential that medical staff identify symptoms more effectively, change habitual medical behavior of the patients, adopt a medical union model, and promote the use of a social medical support system to address practical difficulties in delivering adequate care.

A prospective study on neonatal ophthalmic injuries associated with forceps delivery

Assisted delivery by forceps is needed to expedite vaginal delivery in certain maternal and fetal conditions. The aim of this study was to evaluate the incidence and the extent of ophthalmological injuries in neonates after forceps delivery. Women with cephalic fetuses delivered vaginally by forceps from July 2020 to June 2022 were recruited prospectively. Ophthalmologists would be consulted when there were signs of external ophthalmic injuries, such as periorbital forceps marks or facial bruising. Demographic data, pregnancy characteristics, delivery details, and perinatal outcomes were evaluated to identify any associated risk factors for neonatal ophthalmological injuries. A total of 77 forceps deliveries were performed in the study period, in which 20 cases (26%) required ophthalmological consultations. There were more right or left occipital fetal head positions in the group requiring ophthalmological assessment than those that did not require assessment (35% vs 12.3% [P = 0.023]). The degree of moulding of the fetal head was more marked in the former group (65% vs 28% [P = 0.001]). The overall incidence of detectable ophthalmological lesions was 16.9% (13/77). All ophthalmic injuries were mild, and most resolved with conservative management. In our study cohort, external ophthalmic injuries were common after forceps delivery. We recommended ophthalmological consultation in newborns delivered by forceps with evidence of compressive trauma to rule out serious ophthalmological trauma.

A cross-sectional study of the impact of the COVID-19 pandemic on an ophthalmology consult service in four Michigan community hospitals.

During the coronavirus disease 2019 (COVID-19) pandemic, private practice, inpatient consult services, and academic residency programs in ophthalmology saw a decrease in patient encounters. This study elucidates how community hospital ophthalmology consult (OC) services were affected during the pandemic. We aim to determine whether there was a change in resident OC volume in a community-based ophthalmology program consult service during the COVID-19 pandemic. Secondary objectives included analyzing the change in the types of diagnoses and the number of patients seen for diabetic retinopathy over the same time. A retrospective cross-sectional study was conducted reviewing the electronic health record (EHR) charts from OCs for the period 2017-2021. Records were categorized by referral source and the nature of OCs (trauma, acute, or chronic); OCs were further grouped by year and weak of referral. An intermonth analysis of weekly OC counts in each category was performed for the average number of consults in February-April 2017-2019 and for February-April 2020. A one-tailed t-test was performed. All t-tests assumed equal variances. Weekly OCs in 2020 revealed no statistically significant differences in overall cases or in acute or chronic cases when the volume before the COVID-19 pandemic was compared to the volume after the onset of the pandemic. However, a statistically significant increase in the average weekly trauma cases was noted when 2020 (an average of 2.7 cases per week) was compared to the weekly average for the same weeks of years 2017- 2019 (0.4; P = 0.016). This statistically significant increase in trauma in 2020 disappeared when comparing weeks 11-17 in 2020 (2.2 cases per week) and the average of 2017-2019 (1.1). This report outlines no significant change in OCs before and after the onset of the pandemic compared to three previous years. There was, however, an increase in trauma consults during the pandemic and an increase in the number (though not the proportion) of diabetic retinopathy (DR+) patients seen by residents. This report uniquely describes no significant changes in the resident volume of patients seen during the COVID-19 global pandemic.

Perspectives from an Ophthalmic Hospitalist—Changing How We View Hospital-Based Consults

AbstractInpatient and emergency room ophthalmology consults are becoming an increasingly important issue as fewer providers are willing to provide hospital-based coverage. In this Editorial, I explore aspects of this challenge and highlight a potential solution via the role of an ophthalmic hospitalist.