Ophthalmology Clinic Research Articles

Prevalence and characteristics of HTLV-associated uveitis in patients from Bahia, an endemic area for HTLV − 1 in Brazil

BackgroundHTLV-1-associated uveitis (HAU) is an inflammatory reaction of the choroid, retina, optic nerve and vitreous that can lead to vision impairment. The worldwide prevalence of HAU varies widely.ObjectiveTo determine the prevalence of HAU in patients from Salvador, Bahia-Brazil, and describe uveitis type and associated symptoms.MethodsCross-sectional analytical study to determine the prevalence of uveitis in HTLV-1-infected patients recruited in Bahia, Brazil, a region considered endemic for HTLV-1. Patients were enrolled at a local reference center for HTLV (infected) and at an outpatient ophthalmology clinic (noninfected group). All patients were examined by the same ophthalmologist following a single protocol. Prevalence ratios (PR) were calculated.ResultsA total of 168 consecutively examined HTLV-1-infected patients and 410 noninfected patients (randomly selected) were included. Females predominated (82.1%) in the HTLV-1-infected group (versus 64.4% in the uninfected group) (p < 0.001). The mean age of infected and uninfected patients was 53.2 and 62.8 years, respectively (p < 0.001). The prevalence of uveitis in HTLV-1+ and HTLV-1− patients was 7.14% and 0.73%, respectively (PR = 9.76; 95CI%:2.79–34.15; p < 0.01). Bilateral intermediate uveitis, associated with symptoms including visual disturbances and floaters, was most commonly identified in the HTLV-1-infected patients, whereas unilateral anterior uveitis, in association with symptoms such as blurring and ocular pain, was more common in the uninfected group.ConclusionThe prevalence of uveitis in patients with HTLV-1 was markedly higher than in uninfected subjects. HAU patients were mostly asymptomatic and exhibited bilateral presentation, with uveitis more frequently localized in the intermediate chamber.

Viral Conjunctivitis: Findings, Therapy, and Prophylaxis

Viral conjunctivitis is one of the most common acute eye diseases. The fall and winter months are known to be the main season for viral infections which is also reflected in the ophthalmological outpatient clinics. Viral conjunctivitis is often accompanied by symptoms of the upper and lower respiratory tract, fever, chills, arthralgia or skin lesions. The spectrum of pathogens comprises DNA viruses such as Adeno-, Herpes simplex and Molluscum contagiosum as well as RNA viruses. Symptoms caused by pandemic pathogens such as SARS-CoV-2 and mpox viruses can also cause ocular manifestation. Viral conjunctivitis is often self-limiting leaving no residual symptoms, however an ophthalmologist should be consulted if there are inflammatory symptoms of the anterior eye accompanied by visual disturbance. It is particularly important to recognize the affection of corneal or even intraocular structures early to initiate an adequate and effective therapy. Affection of the cornea, vitreus or retina can result in temporary or permanent impairment of the field of vision and visual acuity. The diagnosis is usually made without further tests on the basis of the typical clinical presentation. Rapid tests or PCR diagnostics are also available for confirmation. In most patients the treatment is symptomatically with artificial tears and antibiotic eye drops in cases accompanied by secondary bacterial infections, not prophylactically. If the cornea or other ocular structures are affected by certain viruses, local as well as systemic virostatic therapy is initiated. The most important prophylactic measure is meticulous and consistent hygiene.

Analysis of Age and Gender Factors on the Incidence Rate of Cataracts in the Ophthalmology Clinic

Cataracts are a cause of blindness which accounts for approximately half of all blindness in the world, especially in developing countries. The mechanism of cataract formation is highly multifactorial. Loss of transparency in the nucleus and cortex of the lens of the eye can occur as a result of oxidation of membrane lipids, structural or enzymatic proteins by peroxides or free radicals induced by UV light. Other factors that can cause cataract formation are degenerative processes and diabetes mellitus). Cataract therapy is a surgical procedure by removing the cloudy lens, because no medical therapy has been proven to remove cataracts in adults. There are many methods that can be done with surgery for cataract patients. One of them is phacoemulsification, which is a cataract surgery using a small incision method. In this technique, liquefaction of the lens is made using an ultrasound probe that is inserted through an incision in the cornea or anterior sclera. This study aims to determine the relationship between age and gender with the incidence of cataracts at the Eye Polyclinic Outpatient Installation in 2022. This is a retrospective analytic study by examining data in the Recamedics Department. The data is grouped by age, sex and type of cataracts. There were 197 patients who came to the eye polyclinic in July 2022. From the results of the study, 197 people suffered from cataracts with a percentage of 88 men (45%) and 109 women (55%) and the age group that suffered the most from cataracts was the age group 53-68 years and the most common cataracts were senile cataract. Analysis of the relationship between age and gender with the incidence of cataracts in the Outpatient Installation (Poly Eyes) for the period of July 2022 obtained a value for the relationship between age and the incidence of cataracts P = 0.846 and the relationship between sex and the incidence of cataracts P = 0.01. Conclusion: In this study there is a significant relationship between gender and the incidence of cataracts and there is no relationship between age and the incidence of cataracts.

Ophthalmic Self-Medication Practices and Associated Factors of Using Steroid Eye Drops Among Adult Ophthalmic Patients.

Self-medication is defined as the selection of medicines by individuals to treat self-diagnosed ophthalmic symptoms without consultation of healthcare professionals. Topical steroids can produce severe eye-threatening complications, including the elevation of intraocular pressure (IOP) with possible development of glaucoma and infrequent optic nerve damage. In recent times, many over-the-counter (OTC) ophthalmic preparations are possible without a prescription. There are a lot of concerns about the safety of long-term use of nonprescription ophthalmic drugs, which may lead to a variety of serious ocular complications. To determine the prevalence of self-medication ocular topical steroid practices and associated factors among adult ophthalmic patients attending ophthalmology clinics at King Saud Medical City (KSMC) in Riyadh. A cross-sectional study targeted adults aged 18 or older who had used topical steroids eye drops. The data were collected through interviews, and an online questionnaire was distributed among patients who attended ophthalmology clinics between December 2022 and February 2023. From a total of 308 responses, 92 (29.8%) were using ocular topical, 58 (18.8%) with a prescription, five (1.6%) without a prescription, and 29 (9.4%) with and without a prescription, while 216 (70.1%) did not use it. The frequency of using ocular topical steroids without a prescription among participants was 11 (12%) once and 33 (35%) many times. Additionally, 26 (28.3%) were having complications, mostly eye infections (11, 12.4%), glaucoma (8, 9%), and cataracts (6, 6.7%). The reasons for practicing self-medication ofsteroid eye drops among participants were 14 (15.2%) repeated symptoms, 11 (15.2%) had heard advice from friends, and 11 (15.2%) think they had enough knowledge. The study reported the use of self-medication with steroids in ophthalmology clinics at KSMC, even though detecting a high level of perception and acceptable practices among participants. This practice is mainly due to participants having repeated symptoms and thinking they have enough knowledge. Educating the patients would help in reducing the incidence of self-medication steroid eye drops and its associated complications.

A case study in applying artificial intelligence-based named entity recognition to develop an automated ophthalmic disease registry

PurposeAdvances in artificial intelligence (AI)-based named entity extraction (NER) have improved the ability to extract diagnostic entities from unstructured, narrative, free-text data in electronic health records. However, there is a lack of ready-to-use tools and workflows to encourage the use among clinicians who often lack experience and training in AI. We sought to demonstrate a case study for developing an automated registry of ophthalmic diseases accompanied by a ready-to-use low-code tool for clinicians.MethodsWe extracted deidentified electronic clinical records from a single centre’s adult outpatient ophthalmology clinic from November 2019 to May 2022. We used a low-code annotation software tool (Prodigy) to annotate diagnoses and train a bespoke spaCy NER model to extract diagnoses and create an ophthalmic disease registry.ResultsA total of 123,194 diagnostic entities were extracted from 33,455 clinical records. After decapitalisation and removal of non-alphanumeric characters, there were 5070 distinct extracted diagnostic entities. The NER model achieved a precision of 0.8157, recall of 0.8099, and F score of 0.8128.ConclusionWe presented a case study using low-code artificial intelligence-based NLP tools to produce an automated ophthalmic disease registry. The workflow created a NER model with a moderate overall ability to extract diagnoses from free-text electronic clinical records. We have produced a ready-to-use tool for clinicians to implement this low-code workflow in their institutions and encourage the uptake of artificial intelligence methods for case finding in electronic health records.

Sarcoidosis: experience in a Mexican ophthalmological clinic

BackgroundSarcoidosis is an inflammatory disorder in which patients frequently develop ocular manifestations that precede systemic involvement, sometimes it even presents as an ocular isolated form of the disease. The purpose of this study is to report the ocular and systemic manifestations of sarcoidosis in a series of Mexican patients, as there is a low incidence of the disease in this population.MethodsA retrospective case series of patients with positive classification criteria for sarcoidosis who attended Asociacion Para Evitar la Ceguera en Mexico, IAP between 2011 and 2022. Descriptive statistics were used to report the clinical, laboratory, and imaging findings and treatment. Numerical results were presented using median values and first and third quartiles for distribution.ResultsFourteen patients were included in this study, 10 of them had definite ocular sarcoidosis (biopsy-proven), 4 had presumed ocular sarcoidosis. The median age of onset was 52 (34; 67), with a predominance of female patients (71.4%). Ten patients (71.4%) debuted with ocular manifestations. The most common forms of ocular involvement were bilateral anterior uveitis (50%) and panuveitis (28.6%). Median follow-up was 24 (13–49) months.ConclusionsSarcoidosis is a rare, underdiagnosed condition in Mexico and ocular involvement can be an early manifestation of the disease. Ophthalmologists should be alert to the signs of ocular sarcoidosis and collaborate with a multidisciplinary team to screen for systemic involvement if suspicion is high.

A case report of autosomal recessive bestrophinopathy

The patient is a 40-year-old male who presented to the ophthalmology clinic due to easy visual fatigue for the past 3 months. Two months ago, the patient was misdiagnosed with "bilateral posterior uveitis", but the diagnosis was ruled out after ineffective treatment with corticosteroids. During the current visit, fundus examination revealed yellow-white material exudation below the macular center in both eyes. Considering the results of the ophthalmic examination and the genetic testing of the patient and his son, the patient was diagnosed with autosomal recessive bestrophinopathy.

Evaluation of serum iron status indicators in patients with primary open angle glaucoma.

To investigate the relationship between serum iron status indicators (ferritin) levels and POAG. The files of all glaucoma patients who applied to the ophthalmology clinic between January 2018 and January 2022 were reviewed retrospectively. Laboratory data from fasting blood tests, internal medicine outpatient clinic reports, and extensive ophthalmologic examination data, including fundus photographs showing the optic disc, were collected from the files. A control group was formed from individuals with adequate general and eye health, age- and gender-matched individuals who had undergone examination in the ophthalmology clinic within the same date range. Serum iron status indicators and some laboratory data of POAG patients and healthy controls were compared. Of our participants, consisting of 65 patients with POAG and 72 healthy controls, 84 (61.32%) were female and 53 (38.68%) were male. It was observed that serum ferritin level was significantly higher in POAG patients compared to healthy controls, and the total iron binding capacity was significantly lower (respectively (p = 0.022), (p = 0.002). In logistic regression analysis, it was found that the risk of POAG increased in cases with high serum ferritin levels (OR = 0.982; p = 0.012). In addition, the risk of POAG was found to increase in cases where MCV was lower (OR = 1.121; p = 0.039). This study shows that higher serum ferritin levels are associated with a higher risk of POAG.

The Comparison of Results of Implantation in Two Groups with PanOptix IOL and Synergy IOL

Purpose: compare the results of implantation of two types of premium IOLs (Synergy and PanOptix) according to several criteria.Materials and methods. Patients were treated in the “EyeDoctor” ophthalmology clinic, Almaty, Kazakhstan. Synergy group: 8 people (4 men and 4 women.) PanOptix group: 25 people (9 men and 16 women).Results. A month after the operation, results were special but comparable.Conclusion. It can be concluded that the hybrid IOL Synergy is in not inferion in refractive results to well matched PanOptix.

Familial Cataracts: Profile of Patients and Their Families at a Child Eye Care Tertiary Facility in a Developing Country.

The aim of this study is to describe the clinical profile, pedigree charting, and management of children with familial cataracts at a child eye health tertiary facility in southwest Nigeria. The clinical records of children ≤16 years diagnosed with familial cataracts at the Pediatric Ophthalmology Clinic, University College Hospital Ibadan (Ibadan, Nigeria) from January 1, 2015, to December 31, 2019, were retrospectively reviewed. Information on demographic data, family history, visual acuity, mean refractive error (spherical equivalent), and surgical management was retrieved. The study included 38 participants with familial cataract. The mean age at presentation was 6.30 ± 3.68 years, with a range of 7 months to 13 years. Twenty-five patients (65.8%) were male. All patients had bilateral involvement. The mean duration from onset of symptoms to presentation at the hospital was 3.71 ± 3.20 years, with a range of 3 months to 13 years. In 16 of the 17 pedigree charts obtained, at least one individual was affected in each generation. The most common cataract morphology was cerulean cataract, observed in 21 eyes (27.6%). The most common ocular comorbidity was nystagmus which was observed in seven patients (18.4%). Sixty-seven eyes of 35 children underwent surgery within the period of the study. The proportion of eyes that had best-corrected visual acuity ≥6 / 18 before surgery was 9.1%; this proportion had increased to 52.7% at the last postoperative visit. Autosomal dominant inheritance appears to be the major pattern among our patients with familial cataract. The most common morphological type found in this cohort was cerulean cataract. Genetic testing and counseling services are vital for the management of families with childhood cataract.

Refining the Diagnostic Technique to Determine Prevalence of Demodex Mites in Eyelash Hair Follicles Within Standard Ophthalmic Practice: A Single-Center Outpatient Clinical Study.

A high density of Demodex infestation in human eyelids and eyelash follicles has been implicated in a variety of ocular surface conditions. However, Demodex infestation often goes undiagnosed and untreated, due to an overlap in signs and symptoms with other sources of ocular surface inflammation. We sought to refine the diagnostic technique for outpatient assessment for Demodex infestation and determine prevalence of Demodex mites in the hair follicles of eyelashes from patients in a standard ophthalmic practice. Patients recruited from a single outpatient ophthalmology clinic were examined for the presence of Demodex mites following standard ophthalmic consultation. During anterior segment biomicroscopic examination, investigators searched for cylindrical dandruff and collarettes around the base of patient eyelashes. These were removed, and individual eyelashes manipulated with tweezers to reveal Demodex mites. Presence of Demodex, cylindrical dandruff and collarettes, time taken to identify the first Demodex mite, mean number of Demodex mites per hair shaft, and patient-reported symptoms of blepharitis were recorded and analyzed to determine potential correlations. A total of 173 patients were recruited, of whom 106 were included in Demodex prevalence analyses. Demodex infestation was identified in 100/106 (94%) patients, with a mean time of 2 minutes and 20 seconds taken to find the first Demodex mite and a mean number of 3 mites identified per hair shaft. Presence of Demodex significantly correlated with the presence of cylindrical dandruff (98/106 [92%] patients; p < 0.001), but not with the presence of collarettes (62/106 [58%] patients; p = 0.230) or symptoms of blepharitis (15/106 [14%] patients; p = 0.591). These results highlight the pervasiveness of Demodex infestation, predicted by the presence of cylindrical dandruff, in the eyelashes of patients in a standard ophthalmic practice. They support the use of a non-invasive diagnostic technique to allow fast, simple identification of Demodex by ophthalmologists and optometrists in outpatient clinical practice.

Prediction model of the horizontal trabecular iris angle after phakic posterior chamber implantable intraocular lens surgery.

To determine the predictors of the postoperative horizontal trabecular iris angle (TIA750) after phakic posterior chamber implantable intraocular lens (IOL) surgery. Ophthalmology Clinic Vista Sánchez Trancón. Retrospective case series. This study included 330 eyes implanted with spherical/toric Implantable Collamer Lens (ICL). From 230 eyes implanted with 13.2 mm ICL, these were divided in modelling (n=180) and evaluation group (n=50). Two groups implanted with 12.6 and 13.7 mm (n=50 each) were also used as evaluation. Anterior-segment OCT was used preoperatively to perform anterior chamber biometry (angle-to-angle distance (ATA), crystalline lens rise (CLR), anterior chamber depth (ACD), cornea sagittal depth, pupil diameter, nasal/temporal TIA750; postoperatively for measuring the vault, pupil diameter and nasal/temporal TIA750. Corneal curvature and horizontal visible iris diameter were measured using optical tomography. Bivariate correlation analysis was used to determine associations between preoperative and postoperative horizontal TIA750 with anterior chamber biometry, ICL-related parameters and age. Finally, a multivariate linear regression model (MLR) was constructed for predicting the postoperative TIA750. Horizontal TIA750 reduced from 42.9±8.0 degrees preoperatively to 24.4±5.6 degrees postoperatively. Postoperative TIA750 was positively correlated with the preoperative TIA750, cornea sagittal depth and ACD, and negatively associated with the vault. The main predictors of the postoperative TIA750 were the preoperative parameters, TIA750, ICLsize - ATA and pupil diameter (adjusted-R2=0.39). The limits of agreement between predicted and real TIA750 were close to ±10 degrees. Implantation of a phakic posterior chamber implantable IOL leads to a reduction in TIA750 and the main factors contributing for this are the preoperative TIA750 aperture and the vault.

Efficacy of Oral Dextrose versus Acetaminophen versus Placebo on Pain Relief during Retinopathy of Prematurity Eye Examinations: A Randomized, Double-Blind Controlled Clinical Trial.

To assess the effect of oral dextrose versus acetaminophen versus placebo in pain relief in retinopathy of prematurity (ROP) examination. In this prospective randomized, double-blind controlled clinical trial study performed in the ophthalmology clinic of Shafa Hospital (referral hospital for eye disease), Kerman, Iran, 105 premature neonates with birth weight ≤2000 g and gestational age between 28 and 34 weeks were studied. Pain score measurement with Premature Infant Pain Profile-Revised (PIPP-R) during ROP examination in three intervention groups, acetaminophen group (15 mg/kg oral acetaminophen), dextrose group (one cc of oral dextrose 50%), and placebo group (one cc of distilled water), was done. Out of 105 infants, 33 infants received acetaminophen drops, 35 infants received dextrose drops, and 37 infants received placebo. The mean pain score of the group receiving acetaminophen was 11.39, dextrose 12.17, and placebo 11.54. The acetaminophen group had a lower average PIPP-R score. This difference was not significant between the three groups (P = 0.38). Acetaminophen and dextrose in comparison with distilled water did not show a significant difference in reducing neonatal pain during ROP examinations. However, the PIPP-R score in the acetaminophen group was lower compared to the other groups.

Prospects for predicting long-term treatment outcomes in patients with combat ocular trauma

Introduction. The analysis of experience in changing approaches to organizing medical care for combat eye injuries, changing treatment tactics for such patients during armed conflicts in the 20th and 21st centuries, domestic experience in providing medical care for eye and its adnexal injuries, highlights the search for informative methods of predicting long-term outcomes of the applied treatment methods. The aim of the study was to determine the informativeness of constructing a forecast of functional changes of the visual analyzer based on the results of treatment of patients with eye injuries during dynamic retrospective observation. Materials and Methods: The primary material for the study was medical documentation of combat eye injury patients (data from medical histories, outpatient cards, and discharge summaries) for the period of 2014-2015, who were treated at the National Military Medical Clinical Center "Main Military Clinical Hospital" (NMMCC "MMCH"). Indicators of the functional state of the visual analyzer were evaluated upon admission to the NMMCC "MMCH" and after 180 days following the injury. The study used the proposed F. Kuhn and colleagues' scale for evaluating long-term treatment outcomes (OTS-Ocular Trauma Score). Results. It was found that overall, the results of treatment for combat eye injuries and their adnexa at the NMMCC "MMCH" during the study period of 2014-2015 showed a high correlation with the calculated values of the probability of preserving visual functions according to the OTS scale. Almost all patients with a case of blindness remained blind in the injured eye six months later. In the group with light projection and movement of the hand near the face, an improvement in visual function in most cases (65%) was noted, while, according to the OTS scale, these patients in most cases remain in this group or move to the group with blindness. Cases with visual acuity of 0.005-0.1 after 6 months improve visual acuity with the transition in most cases to 0.1 and above. The same trend, but, as expected, with a higher probability in groups with visual acuity of 0.1-0.4 and above 0.5. The identified discrepancies justify the need for adaptation of the OTS scale for predicting functional changes in combat eye injuries, as it has been developed for use in eye injuries during peacetime. Conclusion: Considering the large number of wounded soldiers with severe eye injuries during the war with rf, scientific research on the implementation of a system for predicting long-term functional outcomes of the treatment of combat eye trauma based on clinical data at the time of initial examination remains relevant. The results obtained with the OTS (Ocular Trauma Score) assessment scale in most cases correspond to the results of the treatment of injured patients in the ophthalmology clinic of the NMMCC "MMCH" in 2014-2015. Further development of the existing OTS system and its adaptation to domestic conditions and the realities of providing ophthalmic care for combat eye trauma is promising for further study.

Late-Onset Neuromyelitis Optica Spectrum Disorder Mimicking a Non-Arteritic Anterior Ischemic Optic Neuropathy-Case Report.

A 60-year-old white woman presented to the emergency department with painless decrease of visual acuity in the left eye (LE). The diagnosis of a non-arteritic anterior ischemic optic neuropathy in the LE was established based on the clinical picture and the results of static perimetry, fluorescein angiography, visual evoked potential, and magnetic resonance imaging (MRI) of the brain and orbit. Six months later, the patient reported visual impairment in the right eye (RE). Best corrected visual acuity (BCVA) in the RE was 5/10. Gadolinium-enhanced MRI showing inflammation of both optic nerves and the optic chiasm in correlation with positivity for immunglobulin G antibody against aquaporin-4 led to the diagnosis of late-onset neuromyelitis optica spectrum disorder. High-dose intravenous methylprednisolone therapy followed by oral tapering was administered and oral azathioprine was started to reduce the risk of further relapse. At discharge, BCVA was 5/5 in the RE. The patient remains under the care of neurology and ophthalmology clinics, with no recurrences for two years. The possibility of neuromyelitis optica spectrum disorder with optic neuritis in older patients is important in the differential diagnosis of ischemic optic neuropathy.

The Color Vision Disorder in Diabetic Patients

Introduction: The visible spectrum (about 400 to 700 nm) with a mosaic of three classes of photoreceptors compose the human visual system. They are sensitive to different wavelength ranges with overlapping. The receivers have high sensitivities at short wavelengths (~440 nm), medium (~535 nm), or longer (~565 nm), which are S, M, and L cones, respectively. The study aimed to determine blue color vision defects in diabetes mellitus.&#x0D; Methods: A cross-sectional study was done at an ophthalmology clinic on 200 eyes (right and left) of patients with DM for a period of 5 one years (2021). Ishihara plates were used initially for screening. The D-15 test was performed for the evaluation of color vision.&#x0D; Results: The mean age of the sample was 45.66±15.65 years. The most frequent disorder visualized was tritanomaly in 63%, followed by trichromate in 27%, and the least disorder was deuteranomaly in 2%. In addition, mixed disorder is seen in 8% of cases. In relation to laterality, right eye tritanomaly was found in 34%, while the left eye was recorded in 29%. The right eye trichromate was observed in 12%, whereas the left eye was reported in 15%. The left eye deuteranomaly was reported more than the right (1.5% vs. 0.5%).&#x0D; Conclusion: Color vision evaluation with good screening color vision test can be detected even before clinically visible diabetic retinopathy. Early detection was helpful in the prevention of vascular changes in the retina. All diabetic patients should be given proper awareness and health education regarding color vision deficiency. Timely assessment of color vision may detect tritanomaly earlier in diabetics.

Development and validation of a risk prediction model for visual impairment in older adults

ObjectivesThis study aimed to determine the risk factors that affect visual impairment in older adults for developing and evaluating a visual impairment risk prediction model. MethodsIn this hospital-based unmatched case-control design study, we enrolled 586 participants (411 in the training set and 175 in the internal test set) from the ophthalmology clinic and physical examination center of a teaching hospital in Liaoning Province, China, from June to December 2020. Visual impairment was defined as best-corrected visual acuity <6/18 (The WHO definition). Possible influencing factors of visual impairment were assessed, including demographic factors, socioeconomic factors, disease and medication factors, and lifestyle. A visual impairment risk prediction model was developed using binary logistic regression analysis. The area under the ROC curve (AUC) was used to evaluate the effectiveness of the proposed prediction model. ResultsSix independent influencing factors of visual impairment in older adults were identified: age, systolic blood pressure, physical activity scores, diabetes, self-reported ocular disease history, and education level. A visual impairment risk prediction model for older adults was developed, showing powerful predictive ability in the training set and internal test set with AUCs of 0.87 (95%CI 0.83–0.90) and 0.81 (95%CI 0.74–0.88), respectively. ConclusionsThe risk prediction model for visual impairment in older adults had high predictive power. Identifying older adults at risk for developing visual impairment can help healthcare workers to adopt appropriate targeted programs for early education and intervention to prevent or delay visual impairment and prevent injuries due to visual impairment in older adults.

Current Challenges and Solution of Ophthalmology during Covid-19: An evidence-based practice

Background: The coronavirus 2019, also known as SARS-CoV-2, is highly contagious and spreads easily through respiratory droplets when an infected person coughs or sneezes. In December 2019 Wuhan China, the virus was first detected and has become a global pandemic. Aim: To maintain an evidence-based ophthalmology practice during the Covid-19 pandemic, some strategies and guidelines that may be considered and to adapt their practices to the challenges presented by the Covid-19 pandemic while still maintaining evidence-based care. Methods: This narrative review study was conducted in ophthalmology department of Akbar Niazi Teaching Hospital (ANTH), Islamabad between January and March 2023. Some guidelines during Covid-19 outbreak were discussed. Results: Identifying and addressing challenges in different care settings is important for maintaining high-quality ophthalmology care during the Covid-19. Minimizing cross-infection of Covid-19 is essential in healthcare settings to protect both healthcare workers and patients. Stringent infection control measures with personal protective equipment (PPE) and routine cleaning of "high-touch" surfaces, are important strategies to reduce the risk of transmission. Implementing a stringent dual screening and triaging process is a crucial step for outpatient care during the Covid-19 pandemic. This helps to identify high-risk patients and provide appropriate care while minimizing the risk of transmission to other patients and healthcare workers. Separating inpatient and outpatient care is another important strategy to minimize interactions and reduce the risk of transmission of Covid-19. Planning logistics and manpower is critical during the Covid-19 pandemic to ensure that healthcare facilities have the necessary resources and staff to meet the needs of patients. The practical implication of this review was to develop strategies for safe routine eye care and surgery to maintain practice. Conclusion: The measures implemented in response to the Covid-19 in ophthalmology clinics can serve as a guide for healthcare facilities facing similar disease outbreaks in the future. Keywords: Challenges; Evidence-based practice; Ophthalmology; SARS-CoV-2.

A Population-Based Analysis of Long-Term Costs and Adverse Events after Pneumatic Retinopexy and Pars Plana Vitrectomy

To comprehensively examine the cost effectiveness, reattachment rate, and complications of pneumatic retinopexy (PnR) compared with pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) within a universal health care system. Population-based, multicenter, consecutive, retrospective longitudinal cohort analysis. We identified consecutive adults aged ≥ 50 years requiring surgery for primary RRD over a 20-year interval between April 1, 2002, and March 31, 2022. Initial surgery was considered the index date for analyses. Pneumatic retinopexy was compared with PPV in all analyses. The primary analysis investigated the mean annualized health care costs comparing PnR to PPV over the 2 years after initial surgery. Secondary analyses examined the primary reattachment rate and complications. In total, 25 665 eligible patients were identified, with 8794 undergoing PnR and 16 871 undergoing PPV. The mean patient age was 65 years and 39% were women. The mean annualized cost after PnR was $8924 and $11 937 after PPV (mean difference, $3013; 95% confidence interval, $2533-$3493; P < 0.001). The primary reattachment rate at 90 days after PnR was 83% and after PPV was 93% (P < 0.001). The risk of cataract or glaucoma surgery was lower after PnR, and the frequency of ophthalmology clinic visits, intravitreal injections, and anxiety was higher after PnR. Hospitalizations and long-term disability were less frequent after PnR. Pneumatic retinopexy, when compared with PPV, was associated with lower long-term health care costs. Pneumatic retinopexy appeared to be effective, safe, and inexpensive, thus offering a viable option for improving access to RRD repair in appropriately selected cases. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Refractive profile of children treated with intravitreal bevacizumab for retinopathy of prematurity.

To study the refractive profile of children after they received intravitreal injection of bevacizumab for retinopathy of prematurity (ROP). The study was conducted at a tertiary eye care hospital in South India. ROP patients of more than 1 year of age, presenting to the Pediatric Ophthalmology Clinic and Retina Clinic and having history of treatment for type I ROP with intravitreal bevacizumab (IVB) or intravitreal bevacizumab and laser photocoagulation were included in the study. Cycloplegic refraction was done, and the refractive status was evaluated. The refractive status of age-matched, full-term children with uneventful perinatal and neonatal history was also recorded and compared to the study group. Among 134 eyes of 67 study subjects, the major refractive error was myopia in 93 eyes (69.4%; spherical equivalent [SE] = -2.89 ± 3.1, range = -11.5 to -0.5 D). There were 75 eyes (56%) with low-to-moderate myopia; high myopia was seen in 13.4%, emmetropia in 18.7%, and hypermetropia in 11.9% of eyes. The majority of them (87%) had with-the-rule (WTR) astigmatism. In 134 eyes, the SE was -1.78 ± 3.2 (range = -11.5 to 4 D); the SE of the 75 eyes with low-to-moderate myopia was -1.53 ± 1.2 (range = -0.50 to -5 D). In the control group, the majority had emmetropia (91.8%). There was no significant association between the age at which IVB had been injected and the development of refractive errors (P = 0.078). The prevalence of low-to-moderate myopia was more than high myopia in patients with zone I and zone II ROP before treatment (60.0% and 54.5%, respectively). Myopia was the major refractive error seen in post-IVB pediatric patients. WTR astigmatism was more commonly seen. The age at which IVB injection had been given had no effect on the development of refractive errors.