Ophthalmology Clinic Research Articles

Comparison between IOL MASTER 500 and MYAH with vector analysis in low and mild anterior corneal astigmatism.

Evaluate the agreement between IOL Master 500 (Carl Zeiss Meditec AG, Germany) and MYAH (Topcon EU, Visia Imaging, Japan) in measuring axial length, keratometry, and anterior corneal astigmatism. Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Messina, Italy. In this prospective study, 40 eyes (right eye 25, left eye 15) of 40 patients were included. Axial length (AL), keratometry (K1, K2), and anterior corneal astigmatism (ACA) were measured. AL, mean K (Kavg) and magnitude of ACA were compared using Bland - Altman plot analysis, parametric and nonparametric statistical analysis. The difference vector and angle of error of the ACA measured by the two devices were evaluated by vector analysis using polar diagrams. Mean and standard deviation with IOL Master and with MYAH device was for AL 24.25 ± 1.22 mm and 24.25 ± 1.22 mm (p = .99), for Kavg 42.75 ± 1.53 D and 42.85 ± 1.52 D (p = .78), for Magnitude of ACA 1.00 ± 0.58 D and 0.89 ± 0.56 D (p = .38) respectively. High correlations were found for AL (R² = 0.999), Kavg (R² = 0.996), and ACA Magnitude (R² = 0.889). Bland-Altman analysis of the two devices found high agreement and absence of proportional bias (MYAH-IOL MASTER) were found between the two assessments for AL (bias = -0.0005 mm, p = .93), Kavg (bias = 0.0955 D, p = .76) and ACA (bias = 0.11 D, p = .41). Limit of agreement (upper/lower LoA, 95%CI) were respectively +0.057/-0.058 mm for AL, + 0.29/-0.09 D for Kavg and +0.49/-0.27 D for ACA. No statistical difference was found between the x-component and y-component of the ACA vector (p > .01), the difference vector (IOL MASTER-MYAH) was +0.14 D axis 159 with an absolute mean angle of error of 7.2 ± 7.5 degree. The instruments appear to be interchangeable for measurements of AL, keratometry, and magnitude of ACA with high agreement between the two devices. Also, in the presence of low astigmatism, the two instruments give the same results in terms of ACA.

Telehealth improves follow-up and monitoring of age-related macular degeneration during the COVID-19 pandemic.

To prevent vision loss, it is important to monitor patients with age-related macular degeneration (AMD) for the development of choroidal neovascularization. The coronavirus disease 2019 (COVID-19) pandemic caused many patients to miss or delay visits. To offset those gaps in care, providers utilized telehealth (TH) to evaluate patients for symptoms of disease progression and provide health education on the importance of continuous monitoring. This study evaluates the impact of TH encounters on the rate of return for recommended in-person examinations for 1103 patients with non-neovascular (dry) AMD seen in an outpatient ophthalmology clinic in 2019 and due for return evaluation after the outbreak of COVID-19 in 2020. Logistic regression analysis was used to identify demographic, clinical, and sociomedical factors associated with TH utilization and in-person return. 422 patients (38%) utilized TH during the study period. Patients who completed a TH encounter were more likely to return for an in-person examination as compared with those who did not receive TH (OR: 1.8, CI 95%: 1.4-2.3, P < 0.001). Completing a TH visit was associated with the detection of new wet AMD (OR: 3.3, 95% CI 1.04-10.6, P = 0.043), as well as with an earlier return for those patients who were found to have disease progression (62 ± 54days vs. 100 ± 57days, P = 0.049). Completing a TH visit increased the rate at which patients with dry AMD returned for recommended in-person eye examinations. In many cases, this permitted the earlier detection of wet AMD, which is linked with achieving better outcomes.

Study on Risk Factors Associated with Severity of Diabetic Retinopathy in Type-2 Diabetic Patients, Attending a Tertiary Care Centre in Kerala

Introduction: Diabetic retinopathy (DR) is a significant public health concern affecting individuals with diabetes mellitus (DM). Despite treatment advances, a substantial proportion of patients do not respond adequately. This study investigates risk factors associated with the progression of non-proliferative diabetic retinopathy (NPDR) to proliferative diabetic retinopathy (PDR) in type-2 diabetes patients. Methods: A retrospective case-control study was conducted on diabetic patients older than 40 years with at least 5 years of Type-2 Diabetes Mellitus history, attending ophthalmology clinic in Government Medical College, Thrissur, a tertiary care hospital. Data from patients with retinal examination showing diabetic retinopathy were analyzed. Records with missing data were excluded. Patients with Proliferative Diabetic Retinopathy (n=153) were compared with those having Non- Proliferative Diabetic Retinopathy (n=230). Various risk factors were assessed using statistical analysis. Results: Among the studied variables, sex, duration of diabetes, serum urea, serum creatinine, serum triglycerides, and chronic kidney disease were significantly different between Proliferative Diabetic Retinopathy and Non-Proliferative Diabetic Retinopathy patients. Binary logistic regression revealed that duration of diabetes (OR = 1.8, 95% CI = 1.1 - 2.39) and serum creatinine (OR =1.8, 95% CI = 1.1 - 2.39) independently influenced Proliferative Diabetic Retinopathy development. Conclusion: This study highlights that longer diabetes duration and elevated serum creatinine levels independently increase the risk of Non- Proliferative Diabetic Retinopathy progressing to Proliferative Diabetic Retinopathy in type-2 diabetic patients. Other factors such as age, gender, hyperlipidemia, systemic hypertension, type of diabetic treatment, and history of ischemic heart disease did not show significant associations with disease progression. These findings emphasize the importance of close monitoring, early detection, and intervention in patients with Non- Proliferative Diabetic Retinopathy, particularly those with a longer diabetic history, to prevent Proliferative Diabetic Retinopathy development. Further research should explore the causal relationship between serum creatinine and diabetic retinopathy progression and evaluate the impact of renal disease management on disease outcomes. Keywords: Diabetic Retinopathy, diabetes mellitus (DM), Type-2 Diabetes Mellitus (T2DM).

Evaluation of the retina, choroid and optic disc vascular structures in individuals with a history of COVID-19

In this study, we aimed to detect changes in posterior segment structures and vascular density caused by COVID-19 using an optical coherence tomography angiography (OCTA) device. The study included 20 eyes of 20 patients no systemic or ocular disease who were followed at the Ophthalmology Clinic of Health Sciences University Antalya Training and Research Hospital. The OCTA images of these individuals taken prior to contracting COVID-19 and six months after recovery were examined. The mean choriocapillaris blood flow was 2.00±0.13mm2 before COVID-19 and 2.08±0.23mm2 after the disease, and the mean subfoveal choroidal thickness was 247.33±7.65μm before the disease and 273.08±4.92μm after the disease, indicating a statistically significant difference (P=0.003, P=0.001, respectively). The mean retinal nerve fiber layer thickness before and after COVID-19 were 119.33±3.88 and 117.50±3.92μm, respectively, representing a statistically significant decrease (P<0.001). This is the first study in the literature to evaluate the post-COVID-19 changes in the vascular structures of the eye compared to the pre-disease values. In this study, we found statistically significant changes in choriocapillaris blood flow, subfoveal chroidal thickness and retinal nerve fiber layer thickness after COVID-19 infection. Further research with a greater sample size is needed to explore the effect of COVID-19 on these parameters.

Predictors of visual outcome after pars plana vitrectomy secondary to proliferative diabetic retinopathy.

Objective: Advanced proliferative diabetic retinopathy can lead to serious ophthalmological complications, including blindness. This research aimed to determine visual outcomes after pars plana vitrectomy secondary to proliferative diabetic retinopathy, as well as to identify its predictors. Methods: This prospective clinical study was performed in the Ophthalmology Clinic of the Clinical Centre University of Sarajevo. 60 subjects (eyes) with performed pars plana vitrectomy secondary to proliferative diabetic retinopathy were included in the study. Results: After univariate linear regression analysis, glucose, HbA1c, vascular endothelial growth factor, previous pan-retinal laser photocoagulation, baseline best corrected visual acuity, gas injection, vitreous haemorrhage, iris rubeosis, and glaucoma were found to be statistically significant parameters associated with postoperative visual outcome (p<0.05). Multivariate linear regression analysis was performed to evaluate the association between factors and postoperative best corrected visual acuity. Only intravitreal vascular endothelial growth factor concentration, previous pan-retinal photocoagulation, and gas injection remained statistically significant associated with postoperative best corrected visual acuity (p<0.05). Conclusion: Vitrectomy is an effective treatment for advanced proliferative diabetic retinopathy. Factors correlated with the better visual outcome are good systemic control, previous pan-retinal photocoagulation, low intravitreal vascular endothelial growth factor concentration, younger age, intraoperative internal gas tamponade, combined phacoemulsification and pars plana vitrectomy surgery, and the absence of postoperative complications. Abbreviations: PDR = proliferative diabetic retinopathy, VEGF = vascular endothelial growth factor, TDR = tractional retinal detachment, BCVA = best corrected visual acuity, DR = diabetic retinopathy, RDD = rhegmatogenous retinal detachment, NVG = neovascular glaucoma, BRVO = branch retinal vein occlusion, CBC = complete blood count, DBT = differential blood count, ESR = erythrocyte sedimentation rate, HbA1c = glycosylated hemoglobin, PHACO = phacoemulsification, ILM = internal limiting membrane, PPV = pars plana vitrectomy, IOP = intraocular pressure, PRP = pan-retinal photocoagulation, ETDRS = Early treatment diabetic retinopathy study.

Development and progression of myopia in emmetropic children in Turkey

Aims: To investigate the development and progression of myopia in emmetrope school-aged children in Turkey.&#x0D; Methods: This retrospective study included emmetrope children aged 6-18 who attended the ophthalmology clinic for regular eye and refractive examinations between 2010 and 2021. Individuals were examined at least twice for six months period. Myopia progression was calculated as the difference between the baseline and the last visit spherical equivalent refractive (SER) values. Individuals were further categorized to determine the age-specific myopia development and progression as 6-11, 12-16, and 17-18 age groups based on the school periods of the country. According to the change in SER values, individuals were classified into those who remain emmetrope and those who develop myopia. &#x0D; Results: A total of 738 eyes of 369 children (222 female, 147 male) with a mean age of 9.4 ± 2.98 (6-18) years were included in the study. The mean follow-up time of patients was 45.62 ± 26.36 (6-130) months. The baseline mean SER value was -0.01 ± 0.10 D (range: -0.375 and +0.375) and -0.44 ± 0.8 (range: -5.00 and +0.375) at the final visit. The overall mean progression was -0.12 ± 0.25 D/year (range: -2.21 and +0.36). 234 eyes (31.75%) developed myopia, and annual SER change was -0.38 ± 0.31 D/year (p

Turkish children myopia progression in the urban area, a retrospective evaluation

Aims: To investigate myopia trends and progression in urban school-aged myopic children in Turkey.&#x0D; Methods: This retrospective study included myopic children aged 6-18 years attending the ophthalmology clinic for regular eye and refractive examinations between 2003 and 2021. Myopia progression was calculated as the difference between the baseline and the last visit spherical equivalent refractive (SER) values. Individuals were further categorized to determine the age-specific myopia progression as 6-11, 12-16, and 17-18 age groups based on the school periods of the country. According to the SER values, individuals were classified into mild, moderate, and high myopic groups. &#x0D; Results: A total of 602 eyes of 301 children (191 female, 110 male) with a mean age of 11.64±2.81 (6-18) years were included in the study. The mean follow-up time of patients was 37.51±19.18 (6-98) months. The baseline mean SER value was -1.5±1.07 D (range: -0.50 and -5.62) and -2.55±1.50 at the final visit. The overall mean myopia progression was -0.35±0.37 D (range: +0.35 D and -3.75 D/year. There were 46 children between 6-11 years, 173 children between 12-16 years, 82 children between 17-18 years, and the annual SER changes were -0.46±0.40 D; -0.37±0.39 D and -0.26±0.29 D in the groups, respectively (p &lt; 0.001). Baseline, final, and annual myopia progression were greater in females. Although there was no statistical significance, myopia progression was faster in moderate myopes (-0.39±0.33 D/a year), followed by mild (-0.35±0.37 D/a year) and high myopes (-0.21±0.20 D/a year) (p=0.37).&#x0D; Conclusion: The progression of myopia in school-aged Turkish children from the Western Black Sea Region is comparable to the world. Our study revealed the greater myopia progression in the youngest children, moderate myopia group, and females. Myopia prevention recommendations should be carefully advised to the youngest female ones to reduce myopia progression.

Parental Stress in a Pediatric Ophthalmology Population.

To determine the rate of parental stress within a pediatric ophthalmology population, parents in an urban or suburban community pediatric ophthalmology clinic were administered the Parental Stress Index Short Form survey. Demographic information and parental depression or anxiety data were collected and analyzed using an independent sample t-test and chi-squared analysis. Stress measures were recorded as percentiles. One hundred and twenty-one surveys revealed the following mean percentiles: Total Stress, 45.9 ± 22.4; Parental Distress (PD), 49.7 ± 19.8; and Parent Child Dysfunctional Interaction (P-CDI), 45.1 ± 23.6. The PD percentiles of the non-married parents, those with positive parental depression or anxiety scores, and those with a high school diploma or less were 55.9 ± 18.5 versus 45.2 ± 19.6, p < 0.01; 55.2 ± 18.6 versus 46.7 ± 19.9, p < 0.05; and 56.8 ± 18.2 versus 47.0 ± 19.8, p < 0.01, respectively. The parents with a high school diploma or less in a suburban environment demonstrated higher PD/P-CDI scores versus those of an urban population. Those with median household incomes (MHI) below USD 60,000 in both the total and suburban populations showed higher PD scores. There is no significant difference in parental stress between the pediatric ophthalmology patients and the general population. The parents who are unmarried, depressed, have a high school degree or less, or an MHI below USD 60,000 experience significantly higher stress levels.

Functional Vision of Pseudophakic Children Attending a Pediatric Ophthalmology Clinic in Southwest Nigeria.

To determine the functional vision of pseudophakic children attending a child eye health tertiary facility in southwest Nigeria. A hospital-based descriptive study of pseudophakic children attending the Pediatric Ophthalmology outpatient clinic of a tertiary facility in southwest Nigeria was conducted between June and November 2021. Details of demography and clinical examination findings were obtained using a semi-structured questionnaire. Information about functional vision was obtained using the Pediatric Eye Questionnaire (PedEyeQ). Data obtained from the PedEyeQ were entered into a Rasch-calibrated PedEyeQ Excel response data sheet. Data analysis was done using Statistical Package for Social Sciences (SPSS) software version 22 (SPSS, Inc). A total of 196 pseudophakic children were recruited. Their ages ranged from 2 to 16 years with a mean of 9.8 ± 3.4 years and there was a male-to-female ratio of 2.2:1. The median functional vision score of pseudophakic children across all age groups was 90.0. The functional vision scores were associated with the laterality of cataract, type of cataract, presence of comorbidities, visual acuity (distance and near) in the better eye, and number of surgeries. The functional vision scores of pseudophakic children were low. Significant predictors of low functional vision scores include surgery for congenital cataract, low average family income, longer duration of time between surgery and recruitment into the study, and poorer best corrected visual acuity in the better eye. The routine assessment of functional vision should be considered an important aspect of pseudophakic children's eye care with a view toward optimizing psychological and social well-being. [J Pediatr Ophthalmol Strabismus. 2024;61(2):138-146.].

Profile of pediatric ophthalmic referrals in a single emergency department in Korea

Purpose: This study was performed to examine a comprehensive profile of ophthalmic (OPH) referrals based on diagnosis in a single emergency department (ED) in Korea.Methods: We analyzed the clinical profiles of children (&lt; 18 years) who underwent immediate OPH referrals in a tertiary hospital ED, from March 2013 through December 2022. Exclusion criteria were a visit related to procedural complication and a discharge before thorough evaluation. We focused on a diagnosis-based high OPH severity requiring emergency surgery or hospitalization. The profiles were compared according to the severity and age group (0-3, 4-6, 7-12, and 13-17 years).Results: A total of 1,939 children consisted of 1,281 (66.1%) with injury and 658 (33.9%) with non-injury. Top 3 injuries were orbital fracture, hyphema, and corneal abrasion, whereas top 3 non-injuries were keratoconjunctivitis, cellulitis, and hordeolum. Children with high OPH severity (54.5%) had significantly lower proportions of girls (26.5% vs. 38.9%), visits on weekend/holiday (34.4% vs. 43.4%), and most non-injury chief complaints, and higher proportions of 13-17 years (41.1% vs. 23.6%), injury (87.7% vs. 40.1%), emergency surgery (4.9% vs. 0.1%), in-ED procedure (9.3% vs. 2.4%), hospitalization (4.0% vs. 0.8%), and most injury mechanisms. With increasing age, high OPH severity, orbital fracture, and hyphema increased in proportions, in contrast to a decreasing tendency in corneal abrasion, keratoconjunctivitis, cellulitis, and hordeolum (all Ps for trend ≤ 0.001). There were 610 (31.5%) children with low OPH severity or no OPH diagnosis.Conclusion: True OPH emergencies may be more common in injured, older, or male children. This finding could be useful in focusing on emergencies while diverting less urgent cases to outpatient departments or outside ophthalmology clinics.

Individuals with Diabetes Mellitus Have a Dry Eye Phenotype Driven by Low Symptom Burden and Anatomic Abnormalities.

Dry eye disease is an umbrella term that includes a variety of symptoms and signs. A link between diabetes mellitus and dry eye disease exists, but the associated phenotype needs further examination. Thus, our aim was to determine how diabetes mellitus relates to the dry eye disease phenotype. A prospective, cross-sectional study was conducted at the Miami Veteran Affairs Medical Center ophthalmology clinic between October 2013 and September 2019. Participants included a volunteer sample of 366 South Florida veterans with one or more symptoms or signs of dry eye disease [Dry Eye Questionnaire-5 ≥ 6 OR tear break-up time ≤ 5 OR Schirmer's test score ≤ 5 OR corneal fluorescein staining ≥ 2]. Participants were divided into three groups: (1) individuals without diabetes mellitus (controls); (2) individuals with diabetes mellitus but without end-organ complications; and (3) individuals with diabetes mellitus and end-organ complications. Dry eye metrics were compared across groups. The main outcome measures included ocular symptom questionnaires [e.g., 5-item Dry Eye Questionnaire, Ocular Surface Disease Index, and ocular pain assessment] and clinical parameters obtained from an ocular surface evaluation. A total of 366 individuals were included (mean age 59 ± 6 years; 89% males; 39% White; 11% diabetes mellitus and end-organ complications; 15% diabetes mellitus but without end-organ complications). Individuals with diabetes mellitus and end-organ complications had lower symptom scores on the dry eye disease and pain-specific questionnaires compared to individuals with diabetes mellitus but without end-organ complications and controls (Ocular Surface Disease Index: 42.1 ± 24.5 vs. 38.9 ± 25.1 vs. 23.6 ± 16.2; p < 0.001; numerical rating scale of ocular pain intensity: 4.9 ± 3.2 vs. 4.3 ± 2.7 vs. 3.5 ± 2.7; p = 0.02). Eyelid laxity was also more severe in the group with diabetes mellitus and end-organ complications (0.69 ± 0.64 vs. 0.73 ± 0.72 vs. 1.08 ± 0.77; p = 0.004) compared to the two other groups. The diabetic dry eye disease phenotype is driven by signs more so than by symptoms, with anatomic eyelid abnormalities being more frequent in individuals with diabetes mellitus and end-organ complications. Given this, ocular surface abnormalities in individuals with DM may be missed if screened by symptoms alone. As such, individuals with DM should undergo a slit lamp examination for signs of ocular surface disease, including anatomic abnormalities.

The accuracy of using vergence formula to screen myopia in children: a cross-sectional study.

To evaluate the accuracy of using the vergence formula to screen myopia in children and adolescents. This was a cross-sectional study conducted between December 2022 and May 2023 at the ophthalmology clinic of Beijing Tongren Hospital. A total of 336 children aged 6 to 12 years with refractive errors were selected according to the inclusion criteria. Biometric measurements, including axial length, corneal thickness, anterior chamber depth, corneal curvature, and lens thickness, were obtained using a biometer. The Calculated spherical equivalent (SE) was then calculated using the vergence formula. Cycloplegic refraction was performed after paralysis of the ciliary muscle, and the subjective SE was recorded. A diagnosis of myopia was made if the subjective SE was ≤ -0.50 diopters. The AL/CR, subjective SE, and calculated SE were not normally distributed (p < 0.05). The AL/CR value was 3.08 (2.81, 3.27), the SE was -1.60 D (-6.00 D, 3.75 D), and the calculated SE was -1.42 D (-6.64 D, 5.73 D). There was no significant difference between the calculated SE and the SE (Z = -2.899, p = 0.004). The AL/CR value was negatively correlated with SE (r = -0.687, p < 0.01), and the calculated SE was positively correlated with SE (r = 0.827, p < 0.01). The area under the ROC curve for predicting myopia using AL/CR and calculated SE was 0.876 and 0.962, respectively, and the difference between the two was significant (p < 0.001). The sensitivity of AL/CR was 84.2%, the specificity was 70.6%, the accuracy was 82.1%, and the Youden index was 0.548. The sensitivity of calculated SE was 83.1%, the specificity was 100%, the accuracy was 85.7%, and the Youden index was 0.831. The vergence formula can be used to evaluate myopia in children and adolescents with relatively high accuracy without cycloplegic refraction.

Randomized controlled trial on the efficacy and safety of autologous serum eye drops in dry eye syndrome.

Autologous serum eye drops (ASEDs), a novel treatment derived from blood serum, have emerged as a groundbreaking solution for managing dry eye syndrome (DES). These drops have shown significant promise in relieving the distressing symptoms of DES. This study aimed to evaluate the safety and effectiveness of ASEDs compared to traditional treatments, which often prove inadequate or result in unwanted side effects, particularly in individuals with moderate-to-severe DES. To evaluate whether ASEDs are safer and more effective than conventional artificial tears in the treatment of moderate-to-severe DES. This multi-centered randomized controlled trial included 240 patients with moderate-to-severe DES from three ophthalmology clinics in China. They were randomly assigned to receive either ASEDs or artificial tears for 12 wk. The primary outcome was the change in the ocular surface disease index (OSDI) score, with secondary outcomes including tear break-up time (TBUT), Schirmer I test, corneal fluorescein staining (CFS), and conjunctival impression cytology (CIC). Statistics analysis was performed using an analysis of covariance with adjustments made for baseline values. Our findings revealed that both ASEDs and artificial tears significantly improved the OSDI score, TBUT, Schirmer I test, CFS, and CIC from baseline to week 12. The ASEDs group showed significantly greater improvement in all these measures than the artificial tears group (all P values < 0.05). The average difference in the OSDI score between the two cohorts was -10.3 (95% confidence interval: -13.6 to -7.0), indicating a substantial improvement in the ASEDs group. The occurrence of adverse events was comparable between cohorts, with no reports of severe adverse events. ASEDs are more effective and safer than artificial tears for mitigating symptoms of moderate-to-severe DES. ASEDs could be an alternative/supplementary therapy for patients with DES less responsive to traditional treatments.

THU668 Euthyroid Graves’ Ophthalmopathy: Case Series

Abstract Disclosure: S.S. Alfadl: None. A.A. Asiri: None. A.A. Jammah: None. O. Alsagheir: None. Introduction: Graves’ ophthalmopathy is an autoimmune disorder that affects the eyes, characterized by swelling, proptosis, lid lag, inflammation and eyelid retraction. A significant proportion of cases are associated with thyrotoxicosis and positive serum TSH receptor antibody tests. Case Description: We present a case series of euthyroid Graves’ ophthalmopathy in patients with a negative TSH receptor antibody. The first case is of a 37-year-old lady who was recently diagnosed with idiopathic intracranial hypertension due to history of recurrent headaches and was found on CT brain to have an incidental empty sella syndrome and findings highly suggestive of thyroid associated orbitopathy. A dedicated MRI orbit showed bilateral mild proptosis with bilateral medial and inferior recti thickening, sparing the tendinous insertion. The involved extraocular muscles show mild peripheral high T2 signals and minimal enhancement on post gadolinium images. The enlarged extraocular muscle demonstrates diffusion restriction with low Apparent Diffusion Coefficient (ADC) value. Clinically, the patient did not exhibit any symptoms of hyperthyroidism or hypothyroidism. She did not notice any changes in her eyes’ appearance, nor any changes in vision or double vision. On examination, she had mild proptosis, no restriction of extraocular movement or provoked double vision. Consequently, she was referred to Ophthalmology for further management. Investigations included a pituitary panel which did not reveal any abnormalities and a thyroid panel which revealed that she was biochemically euthyroid with a negative TSH receptor antibody test. The second case is of a 24-year-old male who is medically free and initially visited the ophthalmology clinic complaining of double vision, without any additional ophthalmic complaints. He was subsequently referred to our care to rule out thyroid eye disease. Clinically, the patient had no indications of thyroid dysfunction. Upon examination, he exhibited severe right eye proptosis with dystopia and early left eye proptosis. CT orbit showed swelling of the right-sided superior rectus, medial rectus, lateral rectus and left-sided superior rectus muscles. The left-sided superior rectus muscle was abutting the optic nerve. Nevertheless, all tendons were spared. Biochemically, he was euthyroid with unremarkable laboratory results. Conclusion: These findings provide insight into the clinical presentation of euthyroid Graves’ ophthalmopathy in patients without thyrotoxicosis or detectable circulating levels of TSH receptor antibodies. Thus, suggesting that thyroid ophthalmopathy might present earlier than Graves’ disease and even earlier than the presence of TSH receptor antibodies. We conclude that a high index of suspicion and proper follow up is recommended in similar patients for the development of Graves’s disease. Presentation: Thursday, June 15, 2023

Development, implementation, and evaluation of a local community-based ophthalmology sentinel surveillance system in a remote rural area in Japan.

Solid and sensitive infectious disease surveillance systems need to be developed and implemented to prevent and control epidemics. Although statutory national infectious disease surveillance systems have been developed in many countries, some challenges remain, such as their limited timeliness, representativeness, and sensitivity, as well as the fact that they cannot capture all local outbreaks that occur in small communities. To overcome these limitations, local community-based infectious disease surveillance systems that meet local needs and can operate with constrained resources need to be developed, especially in remote and rural low-resource areas. This study aimed to develop, implement, and evaluate a voluntary and unique local community-based ophthalmology sentinel surveillance system in Isa city (OSSS-Isa), a remote rural area in Japan. For the development of OSSS-Isa, one hospital in Isa city assumed a leading role and developed a network with all medical institutions - 20 hospitals and clinics in the local community, including two ophthalmology clinics - as sentinel reporting sites. Surveillance was conducted on a weekly basis from Monday to Sunday. The collection, aggregation, and reporting of the surveillance data were implemented promptly on the same day, Monday, using a paper-based form and fax. For the evaluation of OSSS-Isa, the study followed the updated guidelines for evaluating public health surveillance systems proposed by the Centers for Disease Control and Prevention to select the evaluation criteria and develop a questionnaire. The questionnaires were then distributed to 20 hospitals and clinics, with the responses evaluated on a five-point Likert scale. For the implementation of OSSS-Isa, the system issued alerts twice to the networked hospitals and clinics when signs of an increase in the prevalence of a target infectious eye disease appeared in Isa city. After the alerts, the number of cases decreased in the community. Regarding the evaluation survey, physicians from 18 hospitals and clinics responded to the questionnaire (response rate 90%). In contrast to flexibility, more than 75% of the respondents gave high ratings to simplicity, data quality, acceptability, timeliness, and stability in evaluating OSSS-Isa, with the mean score for these evaluation criteria higher than 3.67. The present results indicate that OSSS-Isa has high simplicity, data quality, acceptability, timeliness, and stability, which is highly embedded with the local healthcare providers in Isa city. OSSS-Isa contributed to the early and accurate detection of signs of infectious eye disease outbreaks emerging in a small remote rural local community. The success factors seem to include its simple well-designed implementation methods, good external factors, and active human factors suited to the characteristics of the small remote rural community. The OSSS-Isa initiative appears to be a meaningful practical example of successful health advocacy by healthcare providers by developing a system at the local social level while going beyond the boundaries of routine medical practice. If voluntary small-scale surveillance systems can complement statutory large-scale ones and work together locally, nationally, and internationally, it might be possible to detect small, unusual happenings that occur in the community, such as emerging infectious diseases, and thereby help avert global outbreaks.

A Cross-Sectional Analysis to Assess the Role of Atopy in Keratoconus Among Saudi Population.

In cases of atopy, IgE antibodies are formed in reaction to certain environmental factors like house dust mites, pollen, or even food allergens. Some studies have shown an association between atopic diseases and keratoconus. This study aims to determine the prevalence of atopy and its associated factors among keratoconus patients. A cross-sectional study was conducted among the Jazan population attending ophthalmology clinics regardless of their sex. Data collection started in August 2020 and finished in mid-June 2021. The sample was selected using the convenience sampling technique, and the total sample size was 83 participants. Data were collected via a questionnaire-based interview that contained 46 questions in the Arabic language. The data collected were analyzed using SPSS software. Family history is the leading predisposing factor for keratoconus (P < 0.001). Also, eye rubbing was a significant (P < 0.015) trigger for keratoconus. However, other factors, including demographic factors such as gender and atopic conditions, did not have any significant association. A combination of genetic and environmental factors is the leading cause of the development of keratoconus; however, family history is the most influential factor, followed by eye rubbing.

Complementary and Alternative Medicine Use Among Patients with Dry Eye Syndrome in Saudi Arabia: A Survey Study.

Complementary and alternative medicine (CAM) includes all healthcare practices that are not part of conventional medicine. One of the most common eye disorders for visiting an ophthalmology clinic is dry eye disease (DED), and due to the increasing number of CAM used for eye conditions, 1 in 5 patients has been reported in previous studies to use CAM for eye treatment. This study aimed to estimate the prevalence of CAM use among patients with (DED). A web-based survey was used to collect the data, the first part of the questionnaire was about demographic data, and the second part included a validated Arabic version of the ocular surface disease index (OSDI). The third part was about practices that alleviate DED other than conventional medicine. The total sample was 282, 61 were males, and 221 were females. Most participants (48.5%) were between 25 and 44 years old, 90% were Saudi, and only 10% were non-Saudi. Of the participant, 70% reported having attained a university or higher education level. The prevalence of the use of CAM among patients with dry eye was around 85%. The most frequently reported type of CAM used among the participants was faith healing (Ruqyah) (41%). This was followed by warm compressors (37%). There was no significant correlation between the severity of OSDI and using CAM, as the p-value was 0.909. In conclusion, our study shows that CAM is a popular choice among patients with dry eye syndrome. Faith healing and warm compressors are the most used types of CAM. However, the lack of correlation between OSDI severity and CAM use indicates that patients may use CAM for reasons other than symptom severity. Further research is needed to explore the reasons behind CAM use and its effectiveness in managing dry eye syndrome.

Алгоритм работы с обращениями граждан: опыт регионального офтальмологического центра.

Relevance. At present, the institution of citizens’ appeals is a dynamically developing model of interaction between the population and state and municipal authorities, including medical organizations. In the legislation of the Russian Federation, for the purpose of a comprehensive, timely and objective procedure for considering citizens’ appeals related to receiving medical care, a three-level hierarchy of regulatory legal regulation has been formed. Determination of the officials of the organization, forms and methods of working with appeals, analysis of the results of consideration of citizens’ appeals and the introduction of measures that correct the activities of employees of a medical organization (medical and non-medical personnel), the implementation of organizational and legal changes are an indispensable element of an effective management system of a modern healthcare institution. The purpose of the study: аnalysis of the organization and conduct of work with citizens’ appeals related to obtaining medical care for the adult population in the field of «ophthalmology» in the regional center of the Republic of Tatarstan – the state autonomous healthcare institution «Republican Clinical Ophthalmological Hospital of the Ministry of Health of the Republic of Tatarstan named after Professor E. V. Adamyuk» (GAUZ “RKOB MH RT named after prof. E. V. Adamyuk”), and the development of measures to improve the efficiency of the ophthalmological clinic. Materials and methods. The analysis of modern requirements of normative legal acts of quality control and safety of medical activity has been carried out, the main tools used in conducting external audits in the system of compulsory medical insurance have been systematized. We used mathematical and statistical analytical methods (quantitative, comparative, structural, expert). Results. A routing scheme for citizens’ appeals is presented, taking into account the channels of their receipt, and an algorithm for working with written appeals sent to the regional ophthalmological center of the Republic of Tatarstan. The trend of modern feedback services with applicants is noted, characterized by the active use of new Internet resources, social networks and instant messengers, various mobile applications for registering citizens’ appeals, and «fan» distribution of complaints about the activities of a medical organization. According to the statistics for 2021–2022 in the structure of the reasons for written appeals of the GAUZ “RKOB MH RT named after prof. E. V. Adamyuk” were in the lead in requests for the provision of medical documentation, which amounted to 2021. 45,4%, 2022 – 55,9% of all received applications. In second place were issues related to the organization of medical care, the share of which amounted to 2021 in 2021. 32,5%, in 2022 – 26,3%. Requests for assistance in the provision of medical care were made in 2021. 12,1%, in 2022 – 8,4% of the total considered appeals. Conclusions. Based on the results of consideration of citizens’ appeals by officials of the GAUZ “RKOB MH RT named after prof. E. V. Adamyuka, managerial decisions are made to increase the satisfaction of the adult population of the Republic of Tatarstan with the quality and availability of medical care in the field of ophthalmology, including changes in the organization of the clinic, the implementation of measures that correct the activities of medical and non-medical personnel.

Evaluation of the Retina and Optic Discs of Patients with Chronic and Episodic Migraine using Optical Coherence Tomography and Optical Coherence Tomography Angiography

Objective: Migraine is a very common,recurring, usually unilateral, severe, pulsating, and transient headache disorder, which causes temporary disability. Migraine has two main types: with aura and without aura. Abnormal retinal and optic disc pathologies in migraine patients were previously reported by using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). In the present study, it was suggested that the changes foundin the retina and optic disc mightindicate a functional disorder in chronic (with and without aura) and episodic (with and without aura) migraine. It is also emphasized that these changes might be useful for early diagnosis and follow-up of the disease, as well as for the development of new treatments. Method: In total, 60 individuals were involved in the present study, including 28 chronic migraine patients (24 female, 4 male, 16 with aura, 12 without aura) and 32 episodic migraine patients (26 female, 6 male, 21 with aura, 11 without aura), who were diagnosed with migraine and whose migraine types were determinedby using the criteria set by the International Headache Society (IHS) in 2013. The control group consisted of 48 healthy volunteers (34 female, 14 male) aged between 18 and 45 years, who applied to the ophthalmology clinic. The retinas and optic discs of the patients were examined by optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) at our ophthalmology clinic. A double-blind randomized analysis was performed for the patient data and the data were compared to control group data of similar gender and age groups. Results: Examining the demographic data, no statistically significant difference was found between the migraine patients and the healthy controls in terms of age, gender, migraine history, and migraine type. However, using Optical Coherence Tomography (OCT), it was determined that the mean vertical and horizontal cup-to-disk (c/d) ratios at the optic disc were significantly impaired in patients compared to the control group. Moreover, using Optical Coherence Tomography Angiography (OCTA), significant reductions in vessel density (VD) were detected in the foveal, parafoveal, perifoveal areas and in the superficial and deep capillary plexuses (SCP and DCP) of the patients. Conclusion: It is thought that these findings might be associated with a vasculopathy developing due to a pathology in the autonomic nervous system or impairments in the cerebral, ocular, or systemic circulation. The authors believe that the results achieved in the present study could be useful in the diagnosis, monitoring, and treatment of the disease.

Трифокальные ИОЛ в коррекции миопии высокой и очень высокой степени

Purpose. To show our results for surgical treatment of patient with high and very high myopia with implaited trifocal IOL. Material and methods. Patients were treated in the «EyeDoctor» ophthalmology clinic (Almaty, Kazakhstan). There were 52 patients in presbiopic age who were treated with implantation of trifocal IOL. Results. Results of our surgical treatment were high enough with several criteria. Conclusion. The implantation of trifocal IOLs give us good results in patients with high and very high myopia. Keywords: high myopia, trifocal IOL, presbyopia, defocus curve, contrast sensitivity