Ophthalmology Clinic Research Articles

Dermoscopy can be safely and reliably used in ophthalmology

ObjectiveTo determine if dermoscopy, a technique widely utilized in dermatology for improved diagnosis of skin lesions, can be used comfortably for evaluating periorbital, eyelid, and conjunctival lesions. DesignProof-of-concept study in which a technique for performing dermoscopy near the eye was developed, related educational material was prepared, and a protocol for dermoscopic image capture was created. MethodsTechnicians used the developed materials to learn to take high-quality pictures with a 10x dermoscope attached to a standard cell phone camera. The images were assessed for diagnostic utility by an oculoplastic surgeon and two dermatologists. Participants115 patients recruited from ophthalmology clinics from July 2021 to April 2023 were photographed, yielding 129 lesions with high-quality dermoscopic images as assessed by an oculoplastic surgeon and two dermatologists. ResultsTechnicians reported a significant increase in confidence (measured on a 1–10 scale) with dermoscopy after training (pre-instruction mean = 1.72, median = 1, mode = 1, IQR = 1.25 vs mean = 7.69, median = 7.75, mode = 7 and 8, IQR = 1.5 post-instruction. Wilcoxon rank sum test with continuity correction, W = 0, p < 0.001, paired t = 13.95, p < 0.0001). Incorporating a contact plate with a 4 × 4mm reticule on the dermoscope aided in photographing ocular and periocular lesions. ConclusionMedical support staff in eye-care offices can be taught to use dermoscopes to capture high-quality images of periorbital, eyelid, and conjunctival lesions. Dermoscopy illuminates diagnostic features of lesions and thus offers a new avenue to improve decision-making in ophthalmology. Dermoscopy can be incorporated into telemedicine evaluations by ophthalmologists, oculoplastic surgeons, or affiliated dermatologists for triage of or rendering advice to patients and for planning of surgery if needed.

E003 A quality improvement project looking into retinopathy screening for patients taking hydroxychloroquine at the Princess of Wales Hospital

Abstract Background/Aims Hydroxychloroquine (HCQ) is widely used in various rheumatic and dermatological conditions and the risk of associated retinal toxicity is more common than previously considered; an overall prevalence of 7.5% in patients taking HCQ for greater than 5 years, rising to 20 to 50% after 20 years of treatment. The Royal College of Ophthalmologists (RCOphth) revised guidelines (2020) advise annual monitoring of all patients for retinopathy who have taken HCQ for &amp;gt; 5 years. Patients with additional risk factors for retinal toxicity may be monitored annually after the initiation of therapy. Methods We reviewed relevant medical records of all the rheumatology patients at Princess of Wales Hospital (POWH) on HCQ from January 2017 to February 2022. Data was collected to include patient demographics and diagnosis, duration on HCQ, whether retinopathy referral was indicated and requested and whether these patients were subsequently seen in the ophthalmology clinic. Results In total we identified 216 patients, and the median age was 60 (range 27-96). All patients had been informed of potential associated retinopathy and were advised to undergo annual assessment by an optician. 60 of these 216 patients had stopped HCQ for various reasons while 156 remained on it. 79 of these 156 were eligible for referral as per the revised RCOphth guidelines as they had received treatment for at least 5 years. 40 of these 79 were referred to ophthalmology and 15 had been reviewed by the ophthalmology service. None of these 15 patients, however, have had further annual ophthalmology reviews after initial assessment. 39 patients had not been referred to ophthalmology despite being on hydroxychloroquine for more than 5 years. If those at high risk are considered, a further 30 of these 156 patients would be eligible for referral. 14 out of these 30 had been referred and none had yet been seen by ophthalmology. Conclusion Using the criteria defined by the revised guidance, approx. 50% of eligible patients had been referred to ophthalmology; 33% of patients have undergone review. Potential reasons for poor adherence to the RCOphth guidelines would likely include the significant changes in guidelines issued in 2017, 2018 and 2020, lack of resources to cope with additional demand in the ophthalmology service and the COVID-19 pandemic which has resulted in significant delays in outpatient services. Following this project, all eligible patients have been referred to ophthalmology and the findings were shared with the dermatology service who are now undertaking a similar audit project. Given the updated referral criteria, we intend to implement a standard referral proforma to ensure all those at risk of retinopathy are identified and will work closely with ophthalmology colleagues to address how best to improve waiting times for such patients to undergo full assessment. Disclosure A. Anjum: None. S. Safdar: None. S. Duffill: None. C. Jenkins: None. S. Smale: None. U. Srinivasan: None.

P003 A fast track giant cell arteritis pathway incorporating ultrasonography improves service provision in a District General Hospital

Abstract Background/Aims Giant cell arteritis (GCA) is the most common form of adult vasculitis with comorbidities including blindness. Early identification and initiation of treatment is therefore essential. The 2020 BSR guideline suggests specialist review within three days of suspected GCA. In Ipswich Hospital, there was previously no universal referral pathway for GCA. Patients were referred to the acute medicine, A&amp;E, rheumatology or ophthalmology clinics. An audit in 2018 over 18 months highlighted a significant delay in specialist reviews. In 2021 we designed a rapid access referral pathway for direct specialist review (protected one-stop slots in rheumatology or ophthalmology), including the use of a dedicated score for assessing the risk for GCA (GCAPS) and vascular ultrasonography in specialist clinics. Our aims for this quality improvement project were to: 1) Audit referral times for suspected GCA patients 2) Optimise the percentage of suspected GCA cases receiving a confirmatory test, notably ultrasound or temporary artery biopsy. Methods We audited the new GCA referrals from January 2022 to June 2023, and compared to the 2018 data. Data were retrospectively collected from electronic health records. Results 44 patients were included (women=29, mean age=68). In 2023, 89% of patients were seen within three days, compared to 47% previously. In 2023, patients were reviewed within a median of two days by a specialist compared to 19 in 2018. Finally, 100% of our patients received a diagnostic test, compared to 79% previously (table 1). A total of 34% of new referrals were diagnosed as GCA. 40 patients had an ultrasound which was positive in 27%, equivocal in 25% and negative in 48%. For the remaining four patients, GCA was excluded without imaging tests/biopsy. 17 patients had biopsy, with 24% being positive for GCA. 52% of referred cases had high GCAPs score and 32% normal inflammatory markers. Conclusion Our fast-track referral pathway facilitated an earlier review for our patients. These results indicate the enhanced safety afforded for suspected GCA patients via a dedicated Fast Track GCA assessment clinic with access to ultrasonography. This also led to a significant reduction in the number of temporal artery biopsies required. Disclosure D. Ioannidis: None. S. Premraj: None. E. Ntatsaki: None.

P010 To establish compliance with British Society for paediatric and adolescent rheumatology (BSPAR) and the Royal College of Ophthalmology (RCOphth) guidelines for screening for uveitis in juvenile idiopathic arthritis (JIA) at a District General Hospital: a retrospective audit

Abstract Background/Aims JIA associated Uveitis (JIA-U) is most common extra-articular manifestation of JIA. The prevalence of uveitis in JIA is approximately 8-30%, but may be as high as 45-57% in young patients with oligoarticular disease. Uveitis is predominantly asymptomatic and requires slit-lamp examination for diagnosis. Up to 67% of JIA-U cases develop ocular complications such as cataracts (20%), glaucoma (19%), band keratopathy (16%), macular oedema and irreversible permanent visual impairment. The primary objective of our audit was to establish compliance of our service with BSPAR/RCOphth 2006 uveitis screening guidelines and therefore reduce the risk of visual complications in children with JIA. Methods A retrospective review of clinical records of children with rheumatological conditions attending our clinic was performed over five-year period. A total of 42 patients with JIA were identified. Data was collated using excel sheet audit tool. Results Results were analysed in accordance with the four major guideline domains as below. 1. Initial Screening exam within 6 weeks of referral: 40 out of 42 children screened within six weeks with 95% compliance rate. 2. Symptomatic patients seen within one week of referral: 4 out of 13 children seen in time with 30% compliance. 70% non-compliance was due to non-availability of ophthalmology appointment. 3. Uveitis may flare on stopping Methotrexate/DMARD’s. Patients should get screened two monthly for six months: 9 out of 13 children were screened with 70% compliance. 15% non-compliance was due to non-availability of ophthalmology appointment. 4. Ongoing screening at two-monthly intervals from onset of arthritis for six months, then 3-4 monthly: 15 out of 20 children screened with 75% compliance. 20% non-compliance was due to non-availability of ophthalmology appointment. Conclusion Practice at our centre as judged against the BSPAR/RCOphth guidelines was suboptimal. The main cause of non-compliance was due to staffing issue, rather than lack of healthcare professional training, delay in onward referral or non-attendance of patients. Non-availability of regular ophthalmology cover with cross-site commitment stretched the uveitis screening service at our centre. We presented this audit in our trust paediatric governance meeting. As a result of this audit, the frequency of paediatric ophthalmology clinics was increased to one a week. The paediatric nurse specialist facilitated liaison with the ophthalmology department and improved compliance with attendance. Patient database on shared drive was regularly updated with separate column for ophthalmology follow-up. The ophthalmologists were granted access to this database detailing clinic attendance and diagnosis. Parent education, reinforced with appropriate literature and a child friendly clinic environment improved awareness and reduces non-attendance. Combined clinics with ophthalmology are being explored. We plan to re-audit the service in near future to assess the impact after above remedial measures. A similar multi-site nation-wide audit may help identify and address local and national concerns. Disclosure K.K. Garg: None. T. Walton: None. A. Holliday: None.

The Effect of Tobacco Smoking on Corneal Endothelium and Central Corneal Thickness

We aimed to study the impact of tobacco smoking towards central corneal thickness, morphology, and corneal endothelial cell density (ECD) in healthy subjects. This cross-sectional study recruited consecutive patients who visited the Ophthalmology Clinic, Universiti Kebangsaan Malaysia Medical Centre, from April 2017 to August 2018 who were active smokers and non-smokers. Active smokers were further divided into heavy and light smokers according to the number of pack-years smoked. The nicotine dependency level was measured using the Fagerstrom test and divided into low, moderate, and severe dependency. Non-contact specular microscopy was performed. Parameters studied included the ECD, percentage of hexagonality (HEX), coefficient of variation of cell size (COV), and central corneal thickness (CCT). A total of 84 eyes from 84 subjects were included, with 42 in the smoker and 42 in the non-smoker groups. The mean age was 38.3 ± 6.7 and 39.2 ± 10.7 years in the smoker and non-smoker groups, respectively. The mean ECD, HEX, and COV were 2783 ± 316 vs. 2877 ± 333 cells/mm2, 55.0 ± 6.7% vs. 55.0 ± 7.7% and 32.7 ± 4.4% vs. 32.2 ± 4.1% in the smoker and non-smoker group, respectively. However, none were statistically significant (p&gt;0.05). The mean CCT was also not statistically different, with 532.6 ± 30.8 μm in the smoker group and 530.5 ± 30.8 μm in the non-smoker group. No statistically significant difference was found between light and heavy smokers and addiction levels. There was a statistically significant but weak negative correlation between ECD and duration of smoking (r = -.370, p = 0.016) and a weak positive correlation between COV and number of pack-years smoked (r = .344, p = 0.025). Smoking did not significantly affect corneal ECD, cellular morphology, or CCT.

Bacterial and Fungal Keratitis in a Tertiary Care Hospital from Romania.

Infectious keratitis is a significant global problem that can lead to corneal blindness and visual impairments. This study aimed to investigate the etiology of infectious bacterial and fungal keratitis, identify the causative pathogens and their antimicrobial resistance patterns, and analyze the risk factors associated with the development of infectious keratitis. The study was observational and retrospective, involving 226 eyes from 223 patients presented at the Ophthalmology Clinic of the County Clinical Emergency Hospital of Craiova, Romania. The inclusion criteria included corneal ulceration/abscess/infiltrate present on slit-lamp examination and positive microbiological sampling for bacteria or fungi. The study found that the most common causes of infectious keratitis were coagulase-negative staphylococci (35.40%), Staphylococcus aureus (11.06%), and Pseudomonas aeruginosa (14.16%). The Gram-positive bacteria showed high resistance rates to penicillin, moderate rates to gentamycin and clindamycin, and low resistance to chinolones. The Gram-negative bacteria were highly resistant to ampicillin and amoxicillin-clavulanic acid, while third-generation cephalosporins, quinolones, and carbapenems were effective. Systemic antibiotics, such as vancomycine, piperacillin-tazobactam, amikacin, and ceftazidime, show promise against keratitis with low resistance rates, whereas carbapenems and topical aminoglycosides had higher resistance, leaving moxifloxacin as a potential topical option for Gram-positive bacteria and Pseudomonas aeruginosa, albeit with resistance concerns for Klebsiella spp. Although fungal keratitis was rare, Fusarium spp. and Candida albicans were the leading fungal pathogens, with incidences of 2.65% and 2.21%, respectively. Candida albicans was broadly susceptible to most antifungals, while Fusarium solani, Curvularia lunata, and Alternaria alternata exhibited resistance to many antifungals. Amphotericin B and caspofungin can be used as systemic antifungals in fungal keratitis. The study also identified risk factors for keratitis such as ocular trauma (65.92%, OR: 2.5), contact lens wear (11.94%, OR: 1.8), and corneal scarring/leukoma (10.17%, OR: 1.6). Keratitis was more frequent in individuals over 60 years old. The findings of this study have implications for the development of effective diagnostic, therapeutic, and preventive strategies for infectious keratitis.

Breaking Barriers in Behavioral Change: The Potential of Artificial Intelligence-Driven Motivational Interviewing.

Patient outcomes in ophthalmology are greatly influenced by adherence and patient participation, which can be particularly challenging in diseases like glaucoma, where medication regimens can be complex. A well-studied and evidence-based intervention for behavioral change is motivational interviewing (MI), a collaborative and patient-centered counseling approach that has been shown to improve medication adherence in glaucoma patients. However, there are many barriers to clinicians being able to provide motivational interviewing in-office, including short visit durations within high-volume ophthalmology clinics and inadequate billing structures for counseling. Recently, Large Language Models (LLMs), a type of artificial intelligence, have advanced such that they can follow instructions and carry coherent conversations, offering novel solutions to a wide range of clinical problems. In this paper, we discuss the potential of LLMs to provide chatbot-driven MI to improve adherence in glaucoma patients and provide an example conversation as a proof of concept. We discuss the advantages of AI-driven MI, such as demonstrated effectiveness, scalability, and accessibility. We also explore the risks and limitations, including issues of safety and privacy, as well as the factual inaccuracies and hallucinations to which LLMs are susceptible. Domain-specific training may be needed to ensure the accuracy and completeness of information provided in subspecialty areas such as glaucoma. Despite the current limitations, AI-driven motivational interviewing has the potential to offer significant improvements in adherence and should be further explored to maximally leverage the potential of artificial intelligence for our patients.

Clinical correlation of CD4 count and dry eye disease (DED) severity among Human Immunodeficiency Virus (HIV) patients: A case study in Voluntary Counseling and Testing Clinic RSUP Prof Ngoerah, Bali

Introduction: Dry eye disease (DED) is a condition affecting the surface of the eye and the stability of tears, influenced by various factors. It has been documented as one of the most common ocular issues in the front segment among individuals with HIV, typically appearing in the later stages of the disease. The study sought to examine the clinical relationship between CD4 count and the severity of the condition. Method: This study was conducted as a cross-sectional analysis within a hospital setting, involving 75 HIV-positive patients (140 eyes) aged between 18 and 50 years. These patients were referred to the ophthalmology clinic in the Voluntary Counseling and Testing (VCT) center due to complaints related to ocular surface issues, and they were enrolled in the study. All patients underwent a thorough ophthalmological assessment, including the completion of a dry eye questionnaire, specifically the Ocular Surface Disease Index (OSDI), and measurement of tear film break-up time (TBUT). Results: The research revealed a notable moderate positive correlation between CD4 count and TBUT (r=0.509; p=0.005), and a negative correlation with OSDI score (r=-0.252, p=0.035). Significant differences were observed in CD4 count between mild and moderate dry eyes (p=0.005) as well as between mild and severe dry eyes (p=0.005). No significant difference was found between moderate and severe dry eyes (p=0.435). The severity of dry eye in HIV patients appears to vary across different clinical stages of the disease, coinfection statuses, and treatment histories, although these differences did not reach statistical significance in the results. Conclusion: A correlation exists between CD4 count and the severity of dry eye disease among HIV patients. HIV patients with lower CD4 counts are at a higher risk of developing severe dry eye disease.

Assessment of eye disorders in brachycephalic cat breeds - a retrospective study of 328 cases (2018-2022)

Excess selective breeding that causes significant changes in the facial structure of brachiocephalic breeds has resulted in potential ophthalmological disorders that put their vision at risk. This study aims to assess the prevalence of ophthalmological disorders in seven cat breeds referred to the Ophthalmology Clinic of the Veterinary Teaching Hospital between January 2018 and January 2022. The medical records of all patients that underwent a complete ophthalmological examination, including patient signalment, clinical signs, routine and complementary ophthalmological test results, diagnosis, frequency, and the dates of visits were closely monitored, and the data were summarized in Microsoft Office Excel 2010®. The mean age at the initial referral was 4.65 years (ranging from 2 months to 14 years). The most prevalent breeds were Persians, British Shorthairs, and Scottish Folds, in descending order, at 35.9% (n=118/328), 27.1% (n=89/328), and 16.1% (n=53/328), respectively. Entropion, conjunctivitis, and corneal necrosis were the most common disorders, each of which was detected in ≥ 100 cats. The lesions’ anatomic localization-wise distribution most frequently involved, in descending order, the conjunctiva, cornea, and eyelid at 42.57% (n=321/754), 25.86% (n=195/754), and 22.14% (n=161/754), respectively. In conclusion, the study aimed to instruct the pet owners and breeders concerning understanding the potential severity of health issues in brachycephalic pet animals, and will undoubtedly contribute to veterinary practitioners’ clinical approach to various eye conditions by determining the most commonly encountered eye disorders in these breeds.

Private equity investment in health care delivery, Australia, 2008-2022.

To examine the scale of private equity investment in Australian health care delivery assets (clinics, hospitals, imaging facilities, other doctor-led health care services). Extraction of information about private equity acquisitions of hospitals, clinics, imaging centres and invitro fertilisation facilities in Australia, 2008-2022, from a commercial database (PitchBook), supplemented by information from publicly available online media sources. Number and value of private equity acquisitions of health care assets, 2008-2022; numbers of clinic parent company and clinic acquisitions, 2017-2022. A total of 75 private equity acquisitions of health care delivery assets in Australia during 2008-2022 were identified; the annual number rose from three acquisitions in 2008 to eighteen in 2022. During 2008-2010, five of seven acquisitions were of invitro fertilisation providers; during 2020-2022, 22 of 39 acquisitions were of clinics or clinic groups, including eleven of eighteen in 2022. The total value of the 39 acquisitions for which purchase price could be ascertained (52%) was $24.1 billion. During 2017-2022, the clinic specialty with the greatest number of private equity acquisitions was general practice (256 of 446 clinics purchased within acquisitions). Seven companies owning ophthalmology clinics (24 clinics) were acquired by private equity. Four private equity acquisitions during 2017-2022 included 60 oncology clinics, all related to a single clinic group. The number of private equity acquisitions of Australian health care delivery assets increased during 2008-2022. Doctors should be aware of the motivations and dynamics of private equity companies, as they are increasingly likely to interact with these firms and assets owned by these firms.

VISUAL OUTCOME OF TRAUMATIC OPTIC NEUROPATHYAFTER STEROID TREATMENT IN KARIADI HOSPITAL

Introduction: The occurrence of Traumatic Optic Neuropathy (TON) often occurs in the form of head injuries resulting from traffic accidents. TON is an important cause of impaired visual function which may be improved with steroid therapy. Objective: To determine the visual outcome in patients with TON treated with steroids in Kariadi Hospital, Semarang Methods: This research was a retrospective study. Thirty patients (20 males and 10 females) with TON in ophthalmology clinic, Kariadi Hospital Semarang between Januari 2019 and December 2020. Visual acuity, contrast sensitivity and color blindness test were included data from medical record. Steroid therapy were divided into 3 groups. Intraveous steroid injection alone, intravenous steroid followed with oral steroid, and oral steroid alone. The Wilcoxon and paired-t test as comparison test of pre-post therapy in one group and friedman test as comparison test in 3 groups. Results: There were 5 cases that received intravenous steroid, 18 cases received intravenous steroid with oral steroid, and 7 cases received oral steroid. There were difference visual acuity in intravenous steroid with oral steroid (p = 0.001), visual acuity in oral steroid (p = 0.017), and color blindness test in intravenous steroid with oral steroid in pre-post therapy groups (p = 0.036). There were no difference in visual acuity, color blindness test, and contrast sensitivity between pre-post therapy groups when compared between 3 groups (p= 0.692, p =0.368, p=0.273). Conclusion: Patients with TON had better visual outcome after treated with intravenous steroid followed with oral steroid.

Development and Evaluation of a New Self-Administered Near Visual Acuity Chart: Accuracy and Feasibility of Usage.

Background: Visual acuity (VA) assessments are crucial in ophthalmology but traditionally rely on in-clinic evaluations. The emergence of telemedicine has spurred interest in creating dependable self-administered VA tests for use beyond standard clinical environments. This study evaluated the practicality and validity of a self-administered near VA card test against traditional Snellen and Rosenbaum Pocket Vision Screener (RPVS) methods for home monitoring and enhancing clinical workflow. Methods: In a cross-sectional study, a near VA card (Hadassah Self-Visual Acuity Screener (HSVA)) was developed with written and videotaped instructions for self-use. Patients with a minimal best-corrected VA (BCVA) of 1.0 LogMAR in at least one eye were recruited from ophthalmology and optometry clinics. Outcomes included the mean BCVA difference between the self-administered values and those obtained by the examiner, and correlations between BCVA values obtained by the Snellen, RPVS, HSVA, and previous distance BCVA methods according to the patients' electronic medical records. Results: A total of 275 participants (mean age: 42.5 ± 19.4 years; range: 18-89 years; 47% female) were included. Test-retest reliability analysis of the HSVA demonstrated a very good correlation and repeatability (n = 38 patients; Rs = 1.0; p < 0.001). Accuracy analysis revealed the mean LogMAR BCVA values of an additional 237 patients obtained by the Snellen, RPVS, and HSVA methods were similar (p = 0.10). The self-test BCVA results obtained by the HSVA agreed with the masked examiner-tested VA results (n = 67 patients; p = 0.17; Rs = 0.87; ICC = 0.96). Similar results were obtained when stratification by median age (42 years) was performed. Bland-Altman analysis of the HSVA and RPVS methods demonstrated a good agreement. To assess whether the HSVA could predict the VA results in the clinically used charts, multivariate analysis was used and revealed that the HSVA predicted the RPVS results (β = 0.91; p = 0.001; R2 = 0.88), and the self-test HSVA predicted the Snellen VA results within two lines (β = 0.93; p = 0.01; R2 = 0.36). Conclusions: The home-based HSVA assessment exhibited high test-retest reliability, accuracy, and alignment with clinical-standard VA tests. Its efficacy in self-testing mirrored examiner-conducted VA assessments and accurately predicted Snellen VA outcomes, indicating the HSVA's suitability for self-monitoring in chronic ocular conditions or when access to conventional examinations is limited. The utility of self-administered VA tests may extend beyond ophthalmology and optometry, potentially benefiting primary care, emergency medicine, and neurology. Further research is needed to explore and validate the practical applications of remote VA testing.

Assessment of preoperative anxiety and negative automatic thoughts in patients waiting for corneal transplantation

Introduction and aim. In patients waiting for organ transplantation, increased waiting time can increase anxiety by creating negative automatic thoughts. The aim of this study is to examine the relationship between corneal transplant recipients’ negative automatic thoughts and anxiety before organ transplantation. Material and methods. The population of this correlational descriptive study consisted of 108 patients waiting for cornea transplantation in the Eye Bank unit of a hospital in the south east region of Türkiye. The data were obtained from the patients presented to the ophthalmology clinic for transplantation between September and December 2022. A patient information form, the Negative Automatic Thoughts Scale, and the Trait Anxiety Scale were used to collect the data. Percentage distribution, arithmetic mean, logistic regression and correlation analysis were used in the data analysis. Results. It was determined that the mean score of the negative automatic thoughts of the transplant patients participating in the study was 100.69±47.83, and the trait anxiety mean score was 53.06±6.07. There was a positive relationship between neg ative automatic thoughts and trait anxiety at a moderate level, which was statistically significant (p&lt;0.05, r=0.53). Conclusion. It was determined in the study that the patients’ negative automatic thoughts and trait anxiety were high, and their anxiety increased as the negative automatic thoughts increased.

Screening Tools for Spondyloarthritis in Patients With Psoriasis, Uveitis, and Inflammatory Bowel Disease: A Scoping Review.

Extramusculoskeletal manifestations of spondyloarthritis (SpA) may precede the development of articular features. Patients seen in ophthalmology, dermatology, and gastroenterology clinics with uveitis, psoriasis, or inflammatory bowel disease (IBD) may have undiagnosed SpA. We set out to identify and evaluate screening tools for SpA in patients with psoriasis, uveitis, and IBD and determine factors that influence the performance of these instruments. This scoping review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, and Web of Science were searched from inception to January 2022. We identified 13 screening tools for psoriatic arthritis, 2 SpA screening tools for uveitis, and 3 SpA screening tools for IBD. All screening tools were patient-oriented questionnaires except for the Dublin Uveitis Evaluation Tool, a physician-applied algorithm. The questionnaires varied in length, scoring method, cutoff score, and spectrum of included SpA features. Average completion time was less than five minutes. Across the three patient populations, the sensitivities and specificities of these screening tools were comparable in the primary validation cohorts. Sensitivities and specificities were generally lower in secondary validation studies, with marked variability among cohorts. Our results highlight the heterogeneity and limitations of existing SpA screening tools. Although these tools show promise for use within a specific target population, none are generalizable to all patients with extramusculoskeletal manifestations at risk of SpA. Future studies should explore the utility of a generic patient-oriented SpA screening tool that can be applied to patients with psoriasis, uveitis, or IBD; is easy to use and comprehend; and captures all clinical domains of SpA.

Three-year clinical outcome of XEN45 Gel Stent implantation versus trabeculectomy in patients with open angle glaucoma

ObjectiveTo reliably compare the three-year clinical outcome and safety of XEN45 Gel Stent implantation (XEN) vs. trabeculectomy (TRAB) in patients with glaucoma.Subject/methodsWe conducted a retrospective cohort study with patients with primary open angle or pseudoexfoliation glaucoma with uncontrolled intraocular pressure (IOP) undergoing XEN or TRAB at the Innsbruck University Clinic of Ophthalmology and Optometry, Austria and analysed changes in IOP, numbers of IOP-lowering medications, and complete surgical success (i.e., IOP ≤ 18 mmHg, ≥20% IOP reduction and not requiring IOP-lowering medication) up to 36 months postoperatively.ResultsBetween 2013 and 2019, we performed XEN Gel Stent implantation in 58 eyes and trabeculectomy in 84 eyes. From baseline to 36 months, mean IOP decreased from 23.4 to 13.8 mmHg (mean reduction 35%, 95% confidence interval 23–48%, p < 0.001) in the XEN group and from 25.1 to 11.2 mmHg (mean reduction 50%, 41–60%, p < 0.001) in the TRAB group. TRAB provided higher IOP reduction than XEN Gel Stent implantation at 12, 24, and 36 months (all p < 0.05). In XEN versus TRAB, IOP-lowering medication was required by 98.3% vs. 97.6% before surgery (p = 0.781), differed significantly at month 12 (43.2% vs. 2.0%, p < 0.001)but not at month 24 or 36. Complete surgical success was achieved in 40.0% vs. 62.8% at month 24 (adjusted odds ratio 2.70; 1.04–7.00, p = 0.040) and 27.3% vs. 56.8% at month 36 (4.36; 1.25–15.18, p = 0.021).ConclusionCompared to XEN, TRAB was associated with lower intraocular pressure, less IOP-lowering medication, and higher probability of achieving complete surgical success over a 36-month follow-up period.

Epidemiological and histopathological aspects of ocular melanomas in Northeastern Romania.

Ocular melanoma is a rare but complex disease in current medical practice. Our retrospective study spans over a period of 28 years and analyzed uveal and conjunctival melanomas that were consecutively admitted, diagnosed, and treated in the 2nd Ophthalmology Clinic of Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania. The patients were selected from the records of the Department of Pathology of our Hospital, being diagnosed by standard histopathological techniques. The aim of this study was to summarize the epidemiological and pathological aspects of uveal and conjunctival melanomas in Northeastern region of Romania. In our study, we did not notice a predilection of uveal and conjunctival melanoma to one particular gender. The most common histological subtypes of ocular melanomas were the heavily pigmented spindle cell subtype, followed by the epithelioid subtype. Our patients sought medical help in a timely manner, before the systemic invasion of the disease could develop.

Is Blepharoplasty Cost-effective? Utility Analysis of Dermatochalasis and Cost-effectiveness Analysis of Upper Eyelid Blepharoplasty.

This cross-sectional prospective study measured utility values of upper eyelid dermatochalasis to quantify its impact on quality of life and assess cost-effectiveness of upper blepharoplasty. Utility of dermatochalasis was assessed using the standard reference gamble and time trade-off methods, with dual anchor points of perfect eye function and perfect health. The utility value obtained was used to create a Markov model and run a cost-effectiveness analysis of blepharoplasty as a treatment for dermatochalasis while utilizing the societal perspective. One hundred three patients with dermatochalasis recruited from an urban outpatient ophthalmology clinic completed the utility survey. The authors determined utility values for dermatochalasis ranging from 0.74 to 0.92 depending on the measurement method (standard reference gamble/time trade-off) and anchor points. The cost-effectiveness analysis yielded an incremental cost-effectiveness ratio of $3,146 per quality-adjusted life year, well under the conventional willingness-to-pay threshold of $50,000 per quality-adjusted life year. Probabilistic sensitivity analysis with Monte Carlo simulation demonstrated that blepharoplasty would be cost-effective in 88.1% of cases at this willingness-to-pay threshold. Dermatochalasis has an impact on quality of life that is significantly associated with level of perceived functional impairment. Rising health care costs have underscored the importance of providing value-based treatment to patients, and the results of this study suggest that blepharoplasty is a cost-effective treatment option for symptomatic bilateral upper eyelid dermatochalasis.

Frosted Branch Angiitis Associated with COVID-19-related Multisystem Inflammatory Syndrome in Children

Purpose: To report a case of frosted branch angiitis associated with COVID-19-related multisystem inflammatory syndrome in children (MIS-C).Case summary: An 8-year-old boy was referred to the ophthalmology clinic with decreased visual acuity in his right eye. The initial best-corrected visual acuity (BCVA) was 20/63 in the right eye and 20/32 in the left eye. Upon fundus examination, bilateral frosted branch-like vascular sheathing and retinal hemorrhage were observed. Optical coherence tomography (OCT) demonstrated macular edema. Fluorescein angiography revealed late staining and leakage of affected retinal vessels. The patient exhibited persistent fever, rash, and gastrointestinal symptoms, accompanied by an increase in inflammatory markers in laboratory tests. Testing for SARS-CoV-2 immunoglobulin G (IgG) was positive, although there was no evidence of any other autoimmune diseases or viral infections. The patient was diagnosed with frosted branch angiitis associated with MIS-C. Treatment included systemic steroids and 1% prednisolone eye drops. After 2 weeks, the BCVA improved to 20/20 in both eyes, and all clinical signs resolved without recurrence.Conclusions: In patients with frosted branch angiitis without any other apparent cause, the possibility of MIS-C should be considered. Testing for COVID-19 infection is recommended.

A new segmentation algorithm for peripapillary atrophy and optic disk from ultra-widefield Photographs

Background and objectiveThe prevalence of myopia and high myopia is increasing globally, underscoring the growing importance of diagnosing high myopia-related pathologies. While existing image segmentation models, such as U-Net, UNet++, ResU-Net, and TransUNet, have achieved significant success in medical image segmentation, they still face challenges when dealing with ultra-widefield (UWF) fundus images. This study introduces a novel automatic segmentation algorithm for the optic disc and peripapillary atrophy (PPA) based on UWF fundus images, aimed at assisting ophthalmologists in more accurately diagnosing high myopia-related diseases. MethodsIn this study, we developed a segmentation model leveraging a Transformer-based network structure, complemented by atrous convolution and selective boundary aggregation modules, to elevate the accuracy of segmenting the optic disc and PPA in UWF photography. The atrous convolution module adeptly manages multi-scale features, catering to the variances in target sizes and expanding the deep network's receptive field. Concurrently, the incorporation of the selective boundary aggregation module in the skip connections of the model significantly improves the differentiation of boundary information between segmentation targets. Moreover, the comparison of our proposed algorithm with classical segmentation models like U-Net, UNet++, ResU-Net, and TransUNet highlights its considerable advantages in processing UWF photographs. ResultsThe experimental results show that, compared to the other four models, our algorithm demonstrates substantial improvements in segmenting the optic disc and PPA in UWF photographs. In PPA segmentation, our algorithm improves by 0.8% in Dice, 1.8% in sensitivity, and 1.3% in intersection over union (IOU). In optic disc segmentation, our algorithm improves by 0.3% in Dice, 0.6% in precision, and 0.4% in IOU. ConclusionOur proposed method improves the segmentation accuracy of PPA and optic disks based on UWF photographs, which is valuable for diagnosing high myopia-related diseases in ophthalmology clinics.

Machine learning technology for predicting intraocular lens power. Diagnostics data generalization

Backgraund. Implantation of recent IOLs allows ophthalmologists to effectively solve the problems of surgical rehabilitation of patients with cataracts. The degree of improving the patient's visual functions is directly dependent on the accuracy of the preoperative calculation of the optical power of IOLs. The most famous formulas to calculate this indicator are SRK II, SRK/T, Hoffer-Q, Holladay II, Haigis, Barrett. All of them work well for an "average patient", however, they are not adequate enough at the boundaries of input variables ranges.&#x0D; Aims. To study the possibility of using mathematical models obtained as a result of deep learning of artificial neural networks (ANN models) to generalize data and predict the optical power of modern intraocular lenses.&#x0D; Materials and methods. ANN models were trained on large-scale samples, including depersonalized data for patients of ophthalmology clinic. Data provided in 2021 by ophthalmologist K.K. Syrykh, and reflect the results of both preoperative and postoperative observation of patients. The source file used to build the ANN model includes 455 records - 26 columns of input factors and one column for the output factor - calculating IOL (diopters). To conveniently build ANN models, we used a simulator program, previously developed by the authors.&#x0D; Results. The resulting models, in contrast to the traditionally used formulas, reflect the regional specificity of patients to a much greater extent. They also make it possible to retrain and optimize the structure based on newly received data, which allows taking into account the non-stationarity of the object. A distinctive feature of such ANN models in comparison with the well-known formulas SRK II, SRK/T, Hoffer-Q, Holladay II, Haigis, Barrett, widely used in the surgical cataract treatment in ophthalmology, is their ability to take into account a significant number of recorded input quantities, which makes it possible to reduce the mean relative error in calculating the optical power of IOL from 10–12% to 3.5%.&#x0D; Conclusions. This work shows the fundamental possibility of generalizing a significant amount of empirical data on calculating the optical power of the IOL using training ANN models that have a significantly larger number of input variables than when using traditional formulas and methods. The results obtained allow, in principle, to build an intelligent expert system with a continuous flow of new data from a source and a step-by-step retraining of the ANN model.