Ophthalmology Referral Research Articles

The Use of Non-Person-First Language in Consecutive General Ophthalmology Referrals

To investigate the prevalence of non-person-first language (PFL) in consecutive general ophthalmology referrals to a single tertiary ophthalmology clinic. Retrospective cross-sectional study. Participants included Ophthalmology patients seen for their initial visit to a single tertiary ophthalmology clinic from July 2018 to December 2022. Ten randomly selected referrals from each day were screened for non-PFL as per the American Medical Association and American Psychological Association guidelines. Non-PFL was further categorized into general, diabetes, stigma, obesity, or ageism subcategories. The Chi-square test was used to evaluate associations between non-PFL use and referring provider gender and specialty, length of referral, and patient age and gender. A total of 2625 referrals were included in the study and 136 (5.2%) used non-PFL, such as referring to a person with diabetes as a "diabetic". Error types included Diabetes (38.2%), Stigma (30.9%), General (23.5%), Disability (8.8%), and Obesity (4.4%). Year of referral was predictive of non-PFL (P = .0016), with most occurring in 2020 (9.5%). Non-PFL was significantly more likely to occur in long length referrals compared to medium and short length referrals (16.2% vs. 5.1% vs. 3.5%, P < .001). Referring provider specialty was also predictive of non-PFL (P < .001) with most received by Family Medicine (8.3%), Optometry (4.4%), Emergency Medicine (0.62%), Ophthalmology (4.2%), Others (2.9%). Patient gender (P = .5563), patient age (P = .3466), and referring provider gender (P = .9057) were not predictive of non-PFL. Non-PFL use was most prevalent in 2020, with the most common referral sources being Family Medicine and Optometry. The highest proportions of non-PFL errors made were diabetes and stigma errors. Increased use of PFL in physician-physician communication can decrease intersectional stigma and promote inclusive patient care for ophthalmology patients.

Epidemiological investigation and risk factors of diabetic retinopathy in Yunnan Province

To investigate the prevalence and epidemiological characteristics of diabetic retinopathy (DR) in Yunnan Province, explore its risk factors, and provide a basis for the prevention and treatment of chronic complications of diabetes mellitus (DM). This is a large cross-sectional study, in all, 1 524 DM patients in 16 communities and villages of Yunnan Province who were registered in health service centers were included in this study from August to November 2019. All patients completed a uniform questionnaire, anthropometric measurements, biochemical measurements, and auxiliary examinations. Logistic regression analysis was used to screen the risk factors of DR. The prevalence rates of DR, mild non-proliferative DR (mild-NPDR), and referable DR (RDR) were 16.0% (244/1 524), 4.5% (69/1 524), and 11.5% (175/1 524), respectively. Glycated hemoglobin A1c (HbA1c)≥7.0% was the risk factor of mild-NPDR (OR=1.872, 95%CI 1.055-3.323) and RDR (OR=4.821, 95%CI 2.917-7.969). Blood pressure≥130/80 mmHg (1 mmHg=0.133 kPa) was the risk factor of mild-NPDR (OR=1.933, 95%CI 1.112-3.358) and RDR (OR=1.505, 95%CI 1.063-2.130). In Yunnan Province, 16.0% DM patients had accompanying DR, wherein about 71.7% of them required an ophthalmology referral, and the high incidence of RDR in DM patients was associated with poor control of blood glucose and blood pressure.

Vision Screenings and Ophthalmology Referrals Among a Sample of Pediatricians in Florida.

Introduction In Florida, mandated school vision screenings begin around the age of five.However, a joint statement in the ophthalmology community recommends that primary care providers, including pediatricians, screen for eye and vision symptoms and signs starting at birth. This suggests that pediatricians may be the first to catch signs of early vision loss and refer pediatric patients to an ophthalmologist. This study aims to understand the current vision screening practices of a sample of pediatricians in Florida and how comfort levels with vision screenings may impact ophthalmology referrals. Methods A survey with 36 questions was created by the authors of the study and sent to pediatricians through digital newsletters to the Florida Chapter of the American Academy of Pediatrics and pediatric departments at Florida universities. Descriptive statistics were gathered regarding the demographics of pediatricians surveyed, vision screening attitudes and practices, vision concerns and ophthalmology referrals from pediatric clinics, and the most common reasons for referral to an ophthalmologist. The Jonckheere-Terpstra nonparametric trend test was used to examine whether decreased comfort performing vision screening on a child was associated with lower rates of urgent referrals to an optometrist or ophthalmologist. Results Forty-six responses were collected. Seventy-eight percent of pediatricians reported performing early childhood vision screening (n=36). There was considerable variability in vision screening practices among the pediatricians studied, with only 66% beginning screenings from zero to twoyears of age (n=24). Fifty percent of respondents reported receiving no previous training on performing vision screening, and less than half of respondents reported feeling "somewhat comfortable" or "extremely comfortable" with performing the exam (n=22, 48%).The trend between decreased comfort performing pediatric vision screening and lower rates of urgent eye care referrals was approaching statistical significance (p=0.0705).The majority of urgent referrals were provided by respondents who were somewhat or extremely comfortable with screening (n=13, 65%). Conclusion From this sample of pediatricians in Florida, most respondents reported performing early childhood vision screening, but there was notable variability in the way screenings were performed among pediatricians. Moreover,many had never received training on performing the exam or did not feel comfortable performing them. Decreased comfort with vision screenings was almost significantly associated with decreased urgent referrals to an ophthalmologist.Future studies should examine whether increased training on vision screenings may help improve standardizationof screening practices among pediatrics and comfort with vision screenings.

A Case of Hypertensive Retinopathy With Papilledema Manifested as Blurry Vision, Headache, and Dizziness in a Patient With a Recent Diagnosis of Peritoneal Tuberculosis

Hypertension poses significant risks to various organ systems, including the eyes, leading to target-organ damage known as hypertensive retinopathy (HR). This case report explores the case of a 60-year-old male presenting with blurred vision, headache, and dizziness, ultimately diagnosed with grade IV hypertensive retinopathy. The patient had a complex medical history including hypertension, dyslipidemia, ischemic heart disease, diabetes mellitus, and peritoneal tuberculosis, with recent initiation of anti-tuberculosis therapy. Differential diagnoses encompassed various ocular and systemic conditions, highlighting the importance of a thorough evaluation. Fundoscopic examination revealed bilateral papilledema and flame hemorrhages consistent with hypertensive retinopathy. Management involved meticulous blood pressure control and ophthalmological referral. Collaboration between healthcare providers facilitated comprehensive care. Following treatment, the patient's blood pressure improved, necessitating adjustments in antihypertensive medications. This case underscores the critical role of recognizing ocular manifestations in hypertensive patients and the need for interdisciplinary management to mitigate systemic morbidity and mortality. Ongoing research is crucial to enhance diagnostic and therapeutic strategies for hypertensive retinopathy, ensuring optimal patient outcomes.

P166 Assessing the effectiveness of a musculoskeletal rheumatology back pain questionnaire in early referral and diagnosis of ankylosing spondylitis in uveitis patients

Abstract Background/Aims Spondyloarthritis represents a chronic inflammatory condition primarily targeting the joints of the spine. Uveitis stands as the most common initial extra-articular manifestation of axial spondyloarthritis (SpA), occurring in up to a third of patients. There is a diagnostic delay in axial SpA, with studies showing that the time from symptom onset to diagnosis is 5-7 years. The delay of diagnosis can be attributed to the non-specific presentation of chronic back pain as well as late ophthalmology referrals to rheumatology. A previous audit in our department showed that 25% of uveitis patients who were clinically indicated to have been referred to rheumatology were not. One main objective was to implement the use of the MSK Rheumatology Inflammatory Back Pain Questionnaire as a referral tool, to find out whether the relevant history and questions were asked to all uveitis patients, to mitigate diagnostic delays and enable early management. Methods Patients presenting to the uveitis clinic at NGH were reviewed prospectively from May 2023-July 2023. Medi-viewer/Symphony were used to see patient details, whether the patients were already under rheumatology, any previous episodes and family history. The MSK Rheumatology Inflammatory Back Pain questionnaire was completed by all attending patients. It included 12 questions; a score ⩾4 signified a need for referral. Results A total of 40 patients (M:F ratio 2:3, mean age 52) presented to the uveitis clinic and were reviewed. All patients with uveitis were investigated with the relevant blood tests to rule out any inflammatory conditions. 16 patients were HLA B27 positive. All patients were asked to complete MSK Rheumatology Inflammatory Back Pain questionnaires to rule out inflammatory disease. 60% had back pain history before the age of 45, 21 were of inflammatory type of pain, 15 had disturbed second half of sleep. 25% of patients had other positive inflammatory markers. 40% of patients had a strong family history of HLA-B27. 67% scored ⩾4 on our questionnaire. 23% were already under rheumatology care, 20% were referred to rheumatology and 23 were not referred, of which 13/23 scored ⩽4. The remaining 10 were not referred due to awaiting blood results, further follow up, or lack of systemic features resulting in discharge. Conclusion Uveitis ranks among the most frequent occurrences in the field of ophthalmology, with a significant proportion being associated with HLA-B27. A considerable 40% of uveitis patients have undiagnosed spondyloarthritis due to inadequate referrals. A comprehensive questionnaire and utilising pain scoring can serve as effective tools for directing patients toward proper evaluation for inflammatory diseases. Our study shows that only appropriate cases were referred and had relevant investigations before referral, underscoring the importance of a partnership between ophthalmology and rheumatology to optimise the management of inflammatory spondyloarthritis. Disclosure F. Bangash: None. N. Kalla: None. A. Bangash: None. A. Rahim: None. M. Kamal: None. I. Mahmood: None.

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.

Machine Learning Methods Using Artificial Intelligence Deployed on Electronic Health Record Data for Identification and Referral of At-Risk Patients From Primary Care Physicians to Eye Care Specialists: Retrospective, Case-Controlled Study.

Identification and referral of at-risk patients from primary care practitioners (PCPs) to eye care professionals remain a challenge. Approximately 1.9 million Americans suffer from vision loss as a result of undiagnosed or untreated ophthalmic conditions. In ophthalmology, artificial intelligence (AI) is used to predict glaucoma progression, recognize diabetic retinopathy (DR), and classify ocular tumors; however, AI has not yet been used to triage primary care patients for ophthalmology referral. This study aimed to build and compare machine learning (ML) methods, applicable to electronic health records (EHRs) of PCPs, capable of triaging patients for referral to eye care specialists. Accessing the Optum deidentified EHR data set, 743,039 patients with 5 leading vision conditions (age-related macular degeneration [AMD], visually significant cataract, DR, glaucoma, or ocular surface disease [OSD]) were exact-matched on age and gender to 743,039 controls without eye conditions. Between 142 and 182 non-ophthalmic parameters per patient were input into 5 ML methods: generalized linear model, L1-regularized logistic regression, random forest, Extreme Gradient Boosting (XGBoost), and J48 decision tree. Model performance was compared for each pathology to select the most predictive algorithm. The area under the curve (AUC) was assessed for all algorithms for each outcome. XGBoost demonstrated the best performance, showing, respectively, a prediction accuracy and an AUC of 78.6% (95% CI 78.3%-78.9%) and 0.878 for visually significant cataract, 77.4% (95% CI 76.7%-78.1%) and 0.858 for exudative AMD, 79.2% (95% CI 78.8%-79.6%) and 0.879 for nonexudative AMD, 72.2% (95% CI 69.9%-74.5%) and 0.803 for OSD requiring medication, 70.8% (95% CI 70.5%-71.1%) and 0.785 for glaucoma, 85.0% (95% CI 84.2%-85.8%) and 0.924 for type 1 nonproliferative diabetic retinopathy (NPDR), 82.2% (95% CI 80.4%-84.0%) and 0.911 for type 1 proliferative diabetic retinopathy (PDR), 81.3% (95% CI 81.0%-81.6%) and 0.891 for type 2 NPDR, and 82.1% (95% CI 81.3%-82.9%) and 0.900 for type 2 PDR. The 5 ML methods deployed were able to successfully identify patients with elevated odds ratios (ORs), thus capable of patient triage, for ocular pathology ranging from 2.4 (95% CI 2.4-2.5) for glaucoma to 5.7 (95% CI 5.0-6.4) for type 1 NPDR, with an average OR of 3.9. The application of these models could enable PCPs to better identify and triage patients at risk for treatable ophthalmic pathology. Early identification of patients with unrecognized sight-threatening conditions may lead to earlier treatment and a reduced economic burden. More importantly, such triage may improve patients' lives.

Amblyopia Care Trends Following Widespread Photoscreener Adoption

Amblyopia can result in permanent vision loss if not properly treated before age 7 years. In 2017, the US Preventive Services Task Force recommended that vision screening should occur at least once in all children aged 3 to 5 years to detect amblyopia. To understand trends and factors associated with screening, referral, or diagnosis of amblyopia before and after photoscreening expansion across a relatively large health care system in late 2017. This is a retrospective cohort study of electronic health record data from patients with a well child care visit at approximately age 3 years (ages 2.75-3.25 years) in a relatively large, multispecialty group practice in Northern California and linked census data between 2015 and 2022. Data were extracted and analyzed from October 2022 through August 2023. Patient sex, race and ethnicity, immunization records, previous well child care visits, and census-level median household income. Vision screening, pediatric ophthalmology referral, or amblyopia diagnosis, compared using adjusted odds ratios (AORs). The study included 2015-2017 data from 23 246 patients aged 3 years with at least 1 well child care visit (11 206 [48.2%] female) compared with 2018-2022 postexpansion data from 34 281 patients (16 517 [48.2%] female). The screening rate increased from 5.7% (424 of 7505) in 2015 to 72.1% (4578 of 6354) in 2022. The referral rate increased from 17.0% (1279 of 7505) in 2015 to 23.6% (1836 of 7792) in 2018. The diagnosis rate was 2.7% (200 of 7505) in 2015, peaked at 3.4% (263 of 7792) in 2018, and decreased to 1.4% (88 of 6354) in 2022. Compared with White patients, patients who were Asian, Black, or Hispanic were less likely to be screened (Asian: AOR, 0.80; 95% CI, 0.72-0.88; Black: AOR, 0.71; 95% CI, 0.53-0.96; Hispanic: AOR, 0.88; 95% CI, 0.80-0.97). Compared with White patients, patients who were Asian or Hispanic were more likely to be referred (Asian: AOR, 1.49; 95% CI, 1.36-1.62; Hispanic: AOR, 1.32; 95% CI, 1.18-1.48) and were more likely to be diagnosed (Asian: AOR, 1.29; 95% CI, 1.07-1.56; Hispanic: AOR, 1.67; 95% CI, 1.33-2.11). In this study, increased availability of photoscreeners was associated with an increase in overall rates of vision screening for children aged 3 years in a relatively large health care system. Given that US rates of visual impairment are predicted to increase, additional targeted interventions would be needed to address remaining disparities in amblyopia care along patient- and clinician-level factors.

ADHERENCE TO INTERVENTIONS AT A FALL CLINIC: PRELIMINARY DESCRIPTIVE DATA FROM A SINGLE ACADEMIC INSTITUTION

Abstract Background Falls and fall-related injuries are major public health concerns. Approximately 50 billion dollars are spent on annual medical costs related to falls. Fall prevention is a priority for promoting active and healthy aging in older adults. Fall prevention clinics enable focused evaluation, identification, and treatment of modifiable risk factors, specifically for falls; however, their effectiveness is dependent upon patient adherence to preventive interventions. Methods We analyzed patients aged &amp;gt; 65 years who visited our fall clinic between February 2021 and February 2023. We took an interdisciplinary approach to improve adherence to recommendations, including follow-up phone calls by a dedicated nurse to confirm adherence, nurse-directed interventions such as Tai Chi sessions, and home environment assessments by a social worker. Results 48 patients were included in this analysis, with a mean age of 84 (65-99), and 85% were female. Fall-specific risk factors identified included impairment of strength, gait, or balance (96%); use of fall-risk-increasing medications (54%); problems with feet affecting gait (40%); visual impairment (29%); and postural hypotension (6%). The adherence rates for our interventions were 48% for physical therapy referrals, 28% for podiatry referrals, 36% for ophthalmology referrals, 47% for other referrals, 75% for vitamin D prescriptions, and 50% for assistive device prescriptions. Conclusions There is room for improvement in adherence to referrals. A larger sample size and longer follow-up period are required to investigate factors related to non-adherence. The delivery of both verbal and written recommendations, the identification of each patient’s barriers, and same-day referrals may help improve adherence.

Impact of an email advice service on filtering and refining ophthalmology referrals in England.

The growing capacity-demand imbalance has necessitated the accelerated digital transformation of eye care services. The role of Oxford Eye Hospital's (OEH) email advice service has become even more relevant in the post-Covid era. We sought to evaluate its impact on referrals to secondary care. The consultant-led OEH email advice service primarily targets primary eye care personnel (optometrists and GPs) requiring clinical advice on patient referral. Emails received between September and November 2020 were analysed for demographic data, contents, characteristics, and outcomes. Thematic analysis was performed. A user feedback survey was conducted. A total of 828 emails were received over the 3-month study period (mean 9.1/day). They were predominantly from optometrists (77.9%) and general practitioners (16.1%). Of the 81.0% (671) relating to clinical advice, over half (54.8%) included images from a variety of modalities, and following review, over half (55.5%) were deemed suitable for management in the community, while 36.5% were referred directly to appropriate subspecialty clinics. Only 8.1% required urgent assessment in eye casualty. Thematic analysis showed that this service was most useful for retinal lesions, optical coherence tomography abnormalities, and borderline abnormal optic discs. No adverse events were identified. User feedback was very positive. A secure email advice service is a safe and low-maintenance modality that provides direct and efficient two-way communication between primary and secondary eye care professionals. It allows rapid response to clinical queries, referral filtering and refinement, and streamlining of patient referral pathways. Users (predominantly optometrists) were overwhelmingly positive about its usefulness in clinical practice.

Systematic ophthalmologic evaluation in cardio-facio-cutaneous syndrome: A genotype-endophenotype correlation.

Cardio-facio-cutaneous syndrome (CFCS) is a rare genetic disorder belonging to the RASopathies, a group of developmental syndromes caused by upregulated RAS/MAPK signaling. Pathogenic variants affecting four genes, KRAS, BRAF, MAP2K1 and MAP2K2, encoding core signal transducers of the pathway, underlie the condition. Major clinical features include a distinctive facies, ectodermal and cardiac anomalies, reduced postnatal growth, intellectual disability, and musculoskeletal abnormalities. Similar to other RASopathies, reports of visual impairment, high refractive error, optic nerve pallor, and other ocular abnormalities have been anecdotally reported in the literature. The aim of our study is to report the prevalence of ophthalmologic abnormalities in a large monocentric cohort of individuals affected by CFCS and explore the occurrence of genotype-endophenotype correlations in this series of patients. We observed that BRAF mutations are associated to a higher prevalence of anisometropia >3D (11.8% vs. 0%) and high astigmatism (29.4% vs. 0%; both p < 0.001) while patients with mutations in other genes had a significantly higher prevalence of myopia >6 D (60% vs. 5.9%; p = 0.012). Pale optic disc was associated with higher prevalence of inferior oblique muscle (IO) overaction (33.3% vs. 0%) and lower prevalence of ptosis (0% vs. 11.8%; both p < 0.001). Combined exotropia, IO overaction and nystagmus were frequent in patients with pale optic nerve. Our findings might suggest the need for earlier ophthalmologic referral for CFCS patients due to high risk of amblyopia, especially those expressing BRAF mutations.

Globe and adnexal trauma at Australian trauma centres

IntroductionIn multisystem trauma, the assessment and management of globe and adnexal trauma is often complex. Ophthalmology input may assist managing such patients. To understand the role of ophthalmology in tertiary trauma centres we report on the management of globe and adnexal trauma at two tertiary trauma centres in Sydney, Australia. MethodA retrospective case series was completed at Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) on patients admitted between January 2015 and December 2019. International Classification of Disease, Tenth Revision codes, diagnostic and procedural coding data were used to identify patients admitted with globe and/or adnexal trauma. Data extracted from medical records included demographics, mechanism of injury, ocular examination and specialist ophthalmic referral. ResultsOver 5-years, 773 patients, average age of 53.2years and 62% male, were admitted to RNSH and RPAH with globe and/or adnexal trauma. Most patients (83%) first presented to RNSH or RPAH. The most common mechanism of injury was falls (45%) followed by burns (13%). Two-hundred and thirty-five patients had multisystem trauma, of these patients, 121 (51%) suffered globe trauma with 49 (21%) classified as severe. Three patients were not diagnosed initially due to delayed ophthalmology referral. ConclusionFalls followed by burns were common causes of globe and adnexal trauma in Sydney, Australia. The presence of orbital/mid-facial injury may indicate a patient has globe trauma. In multisystem trauma, globe trauma may be diagnosed late or not identified. Ophthalmology review has an important role in diagnosing and managing globe trauma in multisystem trauma.

Nurse Practitioner Students' Knowledge Assessment and Perceived Preparedness to Triage Ophthalmology Complaints in a Primary Care Setting: An Educational Intervention.

Purpose In this proof-of-concept pilot study, we aimed to increase nurse practitioner (NP) student knowledge of ophthalmology to prepare NPs for encounters in primary care settings. The Association of University Professors of Ophthalmology (AUPO) and the American Academy of Ophthalmology (AAO) endorse core knowledge that medical students should achieve. We assess the effectiveness of an innovative ophthalmologist-led curriculum based on these competencies tailored to issues NPs encounter in primary care. Methods Johns Hopkins University NP students enrolled in a pre-post-cohort study and educational intervention. The didactic program was developed according to AUPO and AAO core ophthalmology content for medical students and was taught in-person by an ophthalmologist. Pre-post-assessments evaluated students' perceived readiness to encounter ophthalmic issues in the clinic and baseline knowledge of core competencies of ophthalmology. Results A total of 42 NP students were included in the analysis. NP students improved in core knowledge and readiness to encounter ophthalmology issues. After the educational event, there was a statistically significant improvement in students' ratings of preparedness to obtain a focused history, exam, perform initial management and decide the urgency of a referral for acute painless vision loss ( p < 0.001), chronic vision loss ( p < 0.001), or a patient with a red/painful eye ( p < 0.001). Students showed a statistically significant improvement in postdidactic event core ophthalmology knowledge assessment scores ( p = 0.002). Conclusion Primary care NPs are increasingly the initial point of contact for patients with ophthalmic complaints, and thus, high-quality and thorough education regarding ophthalmology triage and referral for NPs is necessary. NP student comfort with and knowledge of ophthalmic complaints and triage may be improved by a brief educational intervention taught by an ophthalmologist early in the NP curriculum.

Association between Diabetic Foot Ulcer and Diabetic Retinopathy

Diabetes mellitus is a metabolic disorder with disturbance in carbohydrate, protein and fat metabolism because of partial or complete deficiency of insulin secretion or action. As it can cause various complications and Diabetic retinopathy being the most common and perhaps the most serious of all ocular complications. Diabetic foot ulcer is one of the most serious and disabling complications of diabetes mellitus which result in significantly elevated morbidity and mortality. Aim of the study was to assess the severity of diabetic retinopathy in relation to various grades of diabetic foot ulcer among 100 patients with clinically diagnosed type 2 Diabetes Mellitus with diabetic foot ulcer patients. 25% of the study participants were found to have Moderate NPDR with 15% of the study participants having severe NPDR. 11.1% of study participants with grade 4 DFU had PDR with HRC and 33.3% of study participants with grade 4 DFU had Severe NPDR. 47.1% and 35.3% of study participants with grade 3 DFU had Severe NPDR and moderate NPDR respectively. The association was found to be statistically significant between the severity of diabetic retinopathy and the grades of diabetic foot ulcer of the study participants. The study concluded that the severity of diabetic retinopathy increases with the increase in the stages of DFU and there is a possibility that the presence of DFU can predict the progression to advanced stages of DR. The results of our study support the need for a system of ophthalmological referral in case of detection of DFU, as well as a prompt referral of DR patients to a DFU specialist. Also, in advanced age DFU patients, and particularly those with longer duration of diabetes, early detection of DR and timely treatment may decrease the risk of severe vision loss or blindness. Keywords: diabetic foot ulcer, diabetic retinopathy, risk factors, severity, India

Prevalence of Digital Eye Strain Among University Students and Its Association with Virtual Learning During the COVID-19 Pandemic.

The prolonged use of digital devices is a major risk factor for digital eye strain (DES) syndrome. To estimate the prevalence of DES symptoms among students at Imam Abdulrahman University who use digital devices for virtual learning and leisure activities. This was a retrospective cross-sectional study conducted by asking medical students of Imam Abdulrahman bin Faisal University to complete a self-administered online questionnaire. The questionnaire was used to determine the effect of the hours spent on digital devices and other factors, such as screen distance and not using artificial tears, on the development of DES. The severity (moderate or severe) and frequency (occasionally, always, or never) of 16 eye strain-related symptoms, including eye pain, headache, and itching, were evaluated by using the Computer Vision Syndrome Questionnaire. The overall prevalence of DES in the sample was found to be 68.53%. The largest proportion of students were found to have mild DES (43.20%), and only 11% had severe DES. The most common symptoms reported in our sample were headache, dryness, and burning. Female gender, using smartphones for online classes, and not using eye lubricants were significantly associated with increased severity of DES. In the wake of the COVID-19 pandemic, virtual learning has become an integral part of education, leading to increased use of digital technology. The aim of this study was to investigate the impact of virtual learning on eye strain and to determine the prevalence and effects of DES. A questionnaire was administered to participants, and the findings revealed a DES prevalence of 68.53%. The use of eye drops for lubrication and smartphones for classes was significantly associated with DES. Furthermore, females were found to be more susceptible to severe DES symptoms than males. The development of a tool such as the Computer Vision Syndrome Questionnaire to predict DES prevalence could reduce clinic time and resources by minimizing unnecessary follow-up and ophthalmology referrals.

Characteristics of pediatric ocular trauma in a pediatric emergency department in Japan

IntroductionPediatric ocular trauma is a common complaint in pediatric emergency departments (ED) and is a major cause of acquired monocular blindness. However, data on its epidemiology and management in the ED are lacking. The objective of this study was to describe the characteristics and management of pediatric ocular trauma patients who visited a Japanese pediatric emergency department (ED). MethodsThe present, retrospective, observational study was conducted in a pediatric ED in Japan between March 2010 and March 2021. Children younger than 16 years who visited our pediatric ED and received the diagnosis of ocular trauma were included. ED visits for follow-up examinations for the same complaint were excluded. The patients' sex, age, arrival time, mechanism of injury, signs and symptoms, examinations, diagnosis, history of urgent ophthalmological consultation, outcomes, and ophthalmological complications were extracted from electronic medical records. ResultsIn total, 469 patients were included; of these, 318 (68%) were male, and the median age was 7.3 years. The incident leading to trauma occurred most frequently at home (26%) and most often involved being struck in the eye (34%). In 20% of the cases, the eye was struck by some body part. Tests performed in the ED included visual acuity testing (44%), fluorescein staining (27%), and computed tomography (19%). Thirty-seven (8%) patients underwent a procedure in the ED. Most patients had a closed globe injury (CGI), with only two (0.4%) having an open globe injury (OGI). Eighty-five (18%) patients required an urgent ophthalmological referral, and 12 (3%) required emergency surgery. Ophthalmological complications occurred in only seven patients (2%). ConclusionMost cases of pediatric ocular trauma seen in the pediatric ED were CGI, with only a few cases leading to emergency surgery or ophthalmological complications. Pediatric ocular trauma can be safely managed by pediatric emergency physicians.

Leber Congenital Amaurosis: Leading Cause of Inherited Blindness in Children

Leber congenital amaurosis is a group of severe congenital retinal conditions and the leading cause of inherited blindness in children. Symptoms, typically present in the first 6 months of life, include nystagmus, strabismus, photophobia, abnormal or absent pupillary responses, and cataracts. Eye examinations and visual assessments are an essential part of well-child visits. The primary care practitioner may be the first to identify symptoms or hear parents’ concerning findings during routine eye examinations at well-child or episodic visits. Early recognition of deviations from normal that lead to prompt ophthalmology referrals can result in timely diagnosis and optimized treatment to improve outcomes and quality of life.

Characterization of pentosan polysulfate patients for development of an alert and screening system for ophthalmic monitoring

ObjectifLe polysulfate de pentosan sodique (PPS; ELMIRON, Janssen Pharmaceuticals, Titusville, New Jersey) est un médicament oral approuvé par la Food and Drug Administration américaine dans le traitement de la cystite interstitielle. Or, de nombreux rapports publiés font état de la toxicité rétinienne du PPS. Les études à ce sujet étant surtout de nature rétrospective, des systèmes d'alerte et de dépistage doivent être mis en place pour surveiller activement l'apparition de cet effet secondaire. Notre étude avait pour objectif de dépeindre les tendances en matière de surveillance ophtalmologique au sein d'un échantillonnage de patients qui reçoivent le PPS afin de mettre sur pied un système d'alerte et de dépistage de cette affection. MéthodesUn examen rétrospectif des dossiers médicaux des patients d'un seul établissement a été réalisé entre janvier 2005 et novembre 2020 afin de recenser l'utilisation du PPS. On a ensuite mis au point un système commandant le déclenchement d'une alerte lors de l'ajout de nouvelles ordonnances et de renouvellements d'ordonnances de PPS dans les dossiers médicaux électroniques (DME), de façon à offrir au patient la possibilité de consulter un ophtalmologiste. RésultatsAu total, 1407 patients qui ont pris le PPS pendant la période de 15 ans ont servi à décrire le patient type : 1220 sujets (86,7 %) étaient de sexe féminin; la durée moyenne de l'exposition au PPS était de 71,2 ± 62,6 mois; et l'exposition cumulée moyenne a atteint 669,7 ± 569,2 g. Une consultation en ophtalmologie figurait au dossier de 151 patients (10,7 %), et 71 patients (5,0 %) ont subi une tomographie par cohérence optique (OCT). L'alerte DME s'est déclenchée pour 88 patients sur une période de 1 an, dont 34 patients (38,6 %) qui avaient déjà été examinés par un ophtalmologiste ou avaient été dirigés vers un spécialiste en vue d'un dépistage. ConclusionsUn outil annexé aux DME peut accroître le nombre de patients prenant le PPS qui sont orientés vers un ophtalmologiste en vue du dépistage d'une maculopathie. Cet outil pourrait également être efficace pour réaliser un dépistage longitudinal de cet effet toxique, sans compter qu'il permet d'aviser les prescripteurs de PPS d'un tel risque. Un dépistage efficace pourrait contribuer à identifier les patients qui courent un risque élevé de présenter cette affection.

Vision Screening in Older Adults Admitted with a Fragility Hip Fracture: A Healthcare Quality Improvement Report.

This healthcare quality improvement report focussed on the effectiveness of an orthoptic-led inpatient vision screening service at Nottingham University Hospitals for older adults admitted with a fragility hip fracture. The service was developed in response to national guidance, which recommended a multifactorial assessment, including a vision assessment for older adults presenting following a fall. Vision screening was carried out by orthoptists on eligible patients ≥65 years of age admitted to the trauma and orthopaedic wards with a hip fracture. Retrospective data for patients screened between 2015-2019 were analysed, including: patient demographics; screening eligibility and outcome; ophthalmology referrals made; ophthalmology appointment attendance; and outcome. Of the 3321 patients admitted with a hip fracture between 2015-2019, 2033 (61%) were eligible for vision screening and 1532 (75%) of these were screened. Furthermore, 784 (51%) of the patients screened had an ocular abnormality requiring an ophthalmology referral, or a sight test at an optician. Only 144 of the 383 (38%) who required an ophthalmology referral via the GP were successfully referred, and only 107 of the 186 (58%) patients who were given appointments attended them. Additionally, 98 of 107 had pathology, with cataracts the most common finding (51%), and 61 of 98 (62%) patients had treatable vision impairment. We found a large proportion of fragility hip fracture patients with impaired vision, much of which was treatable and could be detected effectively with orthoptic-led bedside screening. The most common eye problem in those referred to ophthalmology was cataracts. An internal referral pathway to ophthalmology is proposed. There is a need to investigate reasons for disengagement with eye care services in this population.

Online Questionnaire-Based Study on the Knowledge, Attitude, and Practices of Non-Ophthalmic Physicians-in-Training Regarding Exposure Keratopathy Among Patients Admitted in a Tertiary Referral Hospital.

This study aimed to determine the knowledge, attitude, and practices of non-ophthalmic physicians-in-training regarding recognition and prevention of exposure keratopathy among patients admitted in a tertiary referral hospital. This study was a single-center cross-sectional study. An anonymous self-administered online questionnaire was distributed among non-ophthalmic physicians-in-training at the Philippine General Hospital (PGH) using convenience and snowball sampling. A total of 77 responses were recorded with a response rate of 37%. The majority of the respondents uniformly reported the absence of an established eye care protocol or policy being implemented for different subsets of patients at risk for developing exposure keratopathy. Ninety-six percent (96%) was aware of exposure keratopathy. The most urgent reason for referral to the ophthalmology service was the presence of whitish of opacity at 46.8%, while the least urgent reason was the presence of eye redness at 36.4%. Only 43% of the patients with incomplete eyelid closure was referred to the ophthalmology service. The most frequently used modality of prophylactic eye protection treatment was eyelid taping (84.4%) followed by lubricants (drops and gels, 79.1%). The most common reason for not referring was the absence of an established protocol on the appropriate indication for referral to the ophthalmology service. This study showed that the majority of non-ophthalmic physicians-in-training had adequate knowledge and favorable attitude regarding recognition and prevention of exposure keratopathy among patient admitted at the PGH; however, the absence or the unavailability of an eye care protocol among patients with inadequate eyelid closure in our institution on the prevention of exposure keratopathy and its early treatment and appropriate indications for ophthalmology referral resulted in non-uniformity and varied practice patterns on its management.