Ophthalmologic Consultation Research Articles

Recognition of ophthalmology consultation and fundus examination among individuals with diabetes in Japan: A cross-sectional study using claims-questionnaire linked data.

This study aimed to assess the relationship between individuals' recognition of ophthalmology consultation recommendations, their knowledge of the recommended frequency of diabetic retinopathy screening, and the likelihood of undergoing fundus examinations. This cross-sectional secondary analysis linked claims and health checkup data to a questionnaire survey. Questionnaires were distributed to randomly sampled National Health Insurance beneficiaries in Tsukuba City, using data from claims and health checkups. Weighting was applied based on sample extraction and response rates. We calculated the proportions of fundus examinations and knowledge of screening frequency according to the recognition of ophthalmology consultation recommendations. The association between visits to medical facilities with diabetes specialists and diabetic retinopathy screening was also examined. Among 290 participants, 47.6% recognized ophthalmology consultation recommendations. Those who recognized these recommendations had better knowledge of the screening frequency (93.4% vs. 49.6%) and were more likely to undergo fundus examinations (72.9% vs. 30.1%; adjusted risk ratio 2.36; 95% CI, 1.65-3.38). Participants who visited medical facilities with diabetes specialists were more likely to recognize recommendations, have knowledge of screening frequency, and undergo fundus examinations. Recognition of ophthalmology consultation recommendations was associated with better knowledge of screening frequency and higher participation in fundus examinations. Increasing awareness through healthcare provider recommendations may improve diabetic retinopathy screening rates, highlighting the need for targeted interventions to promote eye care among individuals with diabetes.

Artificial intelligence‐powered glaucoma screening: Demographic and clinical comparison between screening attendees and non‐attendees

Aims/Purpose: Investigate demographic and socio‐economic differences between individuals who accepted and declined participation in a glaucoma screening program in Sete Rios Health Center, Lisbon, and identify factors potentially responsible for decrease in screening adherence.Methods: Subset analysis of ongoing prospective study (Clinicaltrial.gov: NCT05875090). Diabetic and healthy patients between 55 and 65 years were invited to an AI‐powered glaucoma screening by both telephone and letter. Demographic, socio‐economic and clinical data were collected through both surveys to the patients and through medical records.Results: 545 subjects (out of 690) were reachable by telephone. 80.0% of those (n = 436) accepted scheduling and roughly 4 out of 5 (72.5%, n = 316) attended the screening visit. Additional 27 people attended screening having received the letter only. Telephone contact revealed overall effectiveness of 45.7% (overall effectiveness of 47.8%). Both screening attendees (S group, n = 343) and non‐attendees (NS group, n = 357) showed homogeneity in age, sex and family history of glaucoma. NS group had a higher percentage of people with more than 12 years of education compared to the S group (42.0% vs 30.5%, p = 0.036). Notably, managers were the professional group which exhibited the highest avoidance rate (47.7%), whereas conversely armed forces occupations showed no refusals. The prevalence of diabetes was significantly higher in the NS group (49.3% vs 32.2%, p = 0.004). Most non‐participants (50.6%) cited prior ophthalmology consultation as their reason for their refusal. Only 15.6% actively refused the screening.Conclusions: These findings shed light on potential barriers to participation and underscore the importance of tailored approaches to engage diverse populations in preventive eye care initiatives.

Expanding Ocular Care in the Emergency Department: A Comprehensive Review of the Utility of Point-of-Care Ultrasound for Ocular Emergencies.

A time-sensitive, sight-threatening ocular condition presenting at an emergency department can be safely diagnosed promptly by ocular ultrasonography (OUS). OUS is a quick, safe, and portable option for assessing severe tissue damage to the periorbital area. OUS can help identify patients who need immediate ophthalmology consultation in a busy setting or when direct ophthalmic examination is unavailable. This review describes the use of OUS to diagnose ocular emergencies, including the indications, anatomy, and conditions (e.g., retinal detachment, vitreous hemorrhage, papilledema, and endophthalmitis) for OUS. Based on the current literature, OUS shows high sensitivity and specificity. Future research should focus on standardizing the use of OUS in clinical practice.

Primary Sjögren's syndrome complicated by renal tubular acidosis and acute bilateral uveitis: a case report and literature review.

Primary Sjögren's syndrome (pSS) is an autoimmune disease that can cause gland dysfunction, leading to dry mouth and dry eyes as the main clinical manifestations. In addition, pSS may affect the gastrointestinal tract, skin, lungs, kidneys, nervous system, eyes, and other organs. We herein report a case involving a 38-year-old woman who presented with a 6-month history of dry mouth and eyes and a 10-day history of fever. She was diagnosed with pSS complicated by renal tubular acidosis, and her symptoms were alleviated after treatment with prednisone and mycophenolate. However, shortly after discontinuation of these medications outside the hospital, she experienced acute vision loss in both eyes. Bilateral uveitis secondary to pSS was diagnosed with the assistance of the Department of Ophthalmology, and the patient was treated with systemic steroids and topical ocular symptomatic therapy. After treatment, her systemic symptoms were relieved and her vision recovered. Although pSS complicated by renal tubular acidosis and uveitis is rare, it can lead to serious consequences such as abnormal renal function, visual impairment, and even blindness if not promptly treated. Steroid and immunosuppressive therapies are effective, and ophthalmology consultation should be performed if necessary for diagnosis and management.

The Effects of Distraction on Cataract Surgery Performance in Consultants and Trainees Using a Simulator.

Mental workload is a recognised concept in medicine, and cognitive overload may lead to complications in surgery, including cataract surgery. A better understanding of what factors contribute to this can potentially improve patient safety and decrease surgeon stress. Simulated cataract surgery is now an essential part of training and a safe environment for exploring the effects of cognitive load upon performance. We used the EyeSi cataract surgery simulator to assess the effects of distraction on surgical performance and on ophthalmology trainees and consultants undertaking cataract surgery. Consultant and trainee cataract surgeons undertook a simulated list of six cases each, of which half were allowed to proceed without extraneous cognitive load with distraction and half were not. Blood pressure and pulse measurements were taken at three intervals in each of the six cases, as well as surgical scores on the simulator recorded for each case. Distraction did not statistically significantly affect the scores, blood pressure or pulse measurements of either the 10 trainees or 10 consultants. Consultants performed more poorly than trainees overall (P = 0.0229) and suffered more serious errors that returned a score of zero for an individual stage (P = 0.0074). Consultant cataract surgeons performed worse than trainees on the EyeSi simulator, raising questions over whether simulation is as true to reality as has been suggested. An important finding is that ophthalmic training curricula around the world have been adapted in order to include simulated cataract surgery as an essential component of training new ophthalmic surgeons.

Association between central corneal thickness and systemic lupus erythematosus: a cross-sectional study protocol.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease affecting multiple systems and classified under connective tissue disorders. Ocular involvement occurs in up to 30% of SLE cases, with the cornea being particularly susceptible to thinning due to immune-complex deposits and its predominantly type I collagen composition. This corneal thinning is clinically significant in glaucoma, where patients with reduced central corneal thickness (CCT) may have up to a threefold increased risk of developing glaucoma, as well as in refractive surgery. However, existing studies on CCT in SLE are limited and marked by substantial heterogeneity in methodology, technology, criteria, and participant numbers, resulting in conflicting findings. Based in our hypothesis that SLE-related corneal lysis may result in decreased CCT, this study aims to determine and compare the mean CCT values between SLE patients and healthy controls to obtain a more precise understanding of the potential relationship. A cross-sectional observational study will be conducted, enrolling SLE patients and age-and sex-matched healthy controls recruited from ophthalmology consultations. Exclusion criteria will be applied to rule out other corneal thinning risk factors. A pilot study estimated a minimum sample size of 34 participants per group. CCT measurements will be obtained using Zeiss HD Cirrus 5,000 optical coherence tomography (OCT) on a randomly selected eye, following concordance analysis using the Kappa index. Statistical analysis will include descriptive, bivariate, and multivariate methods. The study protocol was approved by the ethics committee. The cornea's vulnerability to thinning and lysis in SLE, which impacts CCT, is crucial for the accurate assessment of glaucoma, the leading cause of irreversible blindness worldwide and the second leading cause in Europe. Given that patients with reduced CCT are at a significantly higher risk of developing glaucoma, further research is necessary to understand the association between SLE and CCT. Our study aims to enhance methodological rigor compared to prior research by determining an appropriate sample size and exclusively enrolling SLE patients to increase participant homogeneity. If a significant difference in CCT between groups and an association between CCT and SLE are found, a prospective study will be considered.

Understanding the Dry Eye Disease-Related Symptoms in South America: Prevalence and Associated Factors-A Systematic Review.

Background/Objectives: Dry eye disease is a leading cause of ophthalmologic consultations worldwide and can significantly impact quality of life. While global prevalence rates vary widely, data specific to South America are limited. This systematic review aims to describe and analyze the prevalence and associated factors of dry eye disease-related symptoms in South American populations. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic review was conducted using databases such as PubMed, Web of Science, Scopus, and LILACS. Primary studies in English and Spanish that examined the prevalence of dry eye disease-related symptoms in South American populations and its associated factors were included without date restrictions. Studies were screened and selected based on predefined inclusion and exclusion criteria, resulting in the final inclusion of 16 studies from six South American countries. Results: This review identified significant variability in the prevalence of dry eye disease-related symptoms in South American populations in the region, ranging from 4% to 77.5%, with a mean prevalence of 39.3%. Higher prevalence rates were observed among specific groups, such as university students (58.6%) and administrative workers (57.9%). Factors associated with dry eye disease-related symptoms in South American populations included female sex, older age, prolonged screen time, insufficient sleep, and medical conditions such as hypertension, connective tissue disorders, and the use of medications like antihypertensives and antidepressants. Conclusions: The prevalence of dry eye disease-related symptoms in South American populations is notably higher than global averages, highlighting regional challenges. This study emphasizes the need for standardized diagnostic tools and comprehensive epidemiological research across South America, particularly in underrepresented countries, to inform public health strategies tailored to the specific needs of these populations.

Ocular Manifestations in Paediatric Erythema Multiforme: A Case Report

Erythema multiforme (EM) is a type IV cytotoxic hypersensitivity reaction characterized by classic target lesions on the skin and mucosa, typically affecting the oral, genital, and rarely, ocular mucosa. We describe a 9-year-old girl with widespread rashes, blisters and target lesions on her trunkfor three days. She had eye redness, discomfort, a week-long fever, and a dry cough, without any medication. Ophthalmological examination revealed localized conjunctival injection in her right eye, with no visual impairment or corneal lesions. The diagnosis of EM major (EMM) was based on prior infection, characteristic skin lesions, and mucosal involvement, including ocular manifestation of conjunctival injection. Treatment requires addressing the underlying cause and ophthalmologic consultation for systemic or topical corticosteroids, antibiotics, lubricants, and antihistamines. This case highlights the diagnostic challenges of atypical EM presentations, emphasizing the need for comprehensive evaluation, early recognition, and interdisciplinary collaboration to prevent severe ocular complications and preserve vision.

Online resources for strabismus: an evaluation of readability, complexity, and suitability.

Over one-third of US adults have never attended college, creating a large disparity in the readability of online health materials. Decreased health literacy and accessibility to medical information negatively affect patients and well-informed patients are more likely to experience better health outcomes (1). The NIH and AMA recommend patient-intended education materials be written at a sixth-grade reading level (2), therefore, this study analyzed the accessibility of the top ten web pages for "strabismus." The first ten online resources returned in a Google search for "strabismus" were analyzed. Web pages were then assessed for the readability level (Simple Measure of Gobbledygook), complexity (PMOSE/IKIRSCH), and suitability (Suitability Assessment of Materials). Two independent raters assessed the complexity and suitability. Readability analysis of the strabismus resources revealed an average reading grade level of 11.4 ± 1.07. There was a statistical difference in the reading grade level between the .com and .gov, and the .org and .com websites (p = .029 and p = .031, respectively). Complexity analysis revealed a mean score of 6.50 ± 2.29, corresponding to an 8th-12th grade reading level. The suitability assessment showed a mean value of 70.3 10.1%, representing a "superior" score for the information provided to the reader. The inter-rater agreement was similar for the complexity and fair for the suitability analysis. On average, online resources for strabismus have a low complexity level. However, the majority of the top ten articles reviewed are above the recommended literacy level, indicating a need for revision. The vast amount of available online health resources have significantly affected the field of medicine. Most patients research their disease process using online sources and many reference this material before their initial ophthalmologic consultation. Considering that more than half of Americans read below the equivalent of a sixth-grade level and that the AMA/NIH recommend all patient-intended materials to be written above this level, there is a health literacy disconnect. This limits patients' ability to educate themselves about their medical conditions and participate in informed conversations regarding their healthcare. Patients who are unable to interpret health information accurately have increased rates of hospitalization, develop more medical conditions, and experience a higher rate of mortality. This preventable impediment to informed healthcare care magnifies the urgency for easily readable online resources that are formatted in a manner that is clear to understand and suitable for patients with lower health literacy.

Bio-spectroscopic analysis of corneal structural alterations in dry eye disease: A study of collagen, co-enzymes, lipids, and proteins with emphasis on phytotherapy intervention

Dry eye disease (DED) stands as a prevalent cause for ophthalmology consultations, securing the third position following refractive errors and cataracts. Moreover, the likelihood of experiencing DED escalates with advancing age. In this experimental study corneal tissue alterations due to DED were investigated over different periods by applying both infrared and synchronous fluorescence spectroscopy. The potential effects of instillation of pomegranate and green tea water extracts as green-friendly treatment modalities were also evaluated. The obtained results collectively indicate that DED affects the OH bearing constituents (collagen, glycosaminoglycans, and proteoglycans) of cornea leading to changes in protein secondary structure and the collagen fibrils. Additionally, enhanced dehydrated environment, and reduced energetic/metabolic state, as indicated by co-enzymes, was observed. Phyto-therapeutic administration can contain these alterations with enhanced energetic/metabolic state and increased hydration environment. In conclusion, instillation of green tea extract can protect/restore the collagen fibrils and its potential effects, in general, exceeds that of pomegranate extract.

Ophthalmology inpatient consultations: an Irish tertiary hospital experience.

Ophthalmology consultation on inpatients is often important to optimise eye care and provide information for referring teams. Inpatient consultation may constitute a not-insignificant workload however. This study reports on the nature and necessity of ophthalmology inpatient consults in a large Irish hospital. Retrospective analysis of all consecutive ophthalmology inpatient consultations over a 12-month period. In total, 359 consult requests were received primarily from adult medicine (57.9%), surgery (22%) and paediatric teams (18.4%). The most common reasons for referral were loss of vision (23.7%); visual field testing (15%); diplopia or abnormal eye movements (11.4%); and screening for ocular features of systemic disease (10.6%). Presumptive diagnoses by referring teams were correct in 29.5% of cases. The majority had normal eye examinations (53.2%) or non-sight-threatening features (16.8%), while a minority had acute eye pathology (30%). Most patients (80.4%) required no intervention. A minority required medical (12.5%), orthoptic (4.6%) or surgical (2.4%) intervention. The majority of patients (81%) were fit for transfer to the eye clinic and did not require bedside examination. Our study found a high proportion of ophthalmology inpatient consultations had normal eye exams and required no intervention. The quality of referrals was variable suggesting that clearer guidelines and more ophthalmology education is needed for referring teams.

Glaucoma Surgery SOS: Emergency Department Utilization Greater among Younger and First-Time Surgical Patients with Glaucoma

PurposeTo describe the frequency, findings, and interventions of patients’ emergency department visits after all types of glaucoma surgery DesignRetrospective cohort study SubjectsAll surgical glaucoma patients between 2013 and 2021 MethodsThis single institution study collected demographics, surgery type, and surgical parameters for each patient. Subsequently, for those visiting the emergency department within 50 days of surgery, data was collected on reason for visit, findings, and ophthalmic intervention. Logistic regression models were used to determine the odds of ED visits based on multiple risk factors. Main outcomePostoperative presentation to ED ResultsAmong 9155 surgeries in 5505 patients, 5.7% had ED visits within 50 days, with 46.3% having ocular complaints. Patients with ocular diagnoses presented earlier than those without (p < 0.001). Patients who presented to the ED with an ocular diagnosis were found to be significantly younger than those who did not present (62.2 ± 18.6 vs 65.4 ± 18.0 years old, p < 0.028). Furthermore, white patients were more likely than black patients to present with an ocular diagnosis compared to a non-ocular diagnosis (OR 2.64, 95% CI 1.67-4.18, p<0.001). Patients undergoing their first glaucoma surgery had a much higher chance of presenting to the ED compared to patients who had undergone more than one surgery (OR: 3.75, 95%CI 2.74 – 5.14, p < 0.001). Those who underwent traditional surgeries were more likely than patients with trabecular meshwork bypass stent (TMBS) to present to the ED with an ocular diagnosis (OR: 3.02, 95% CI 1.29 – 7.08, p = 0.011). Filtering surgeries and glaucoma drainage device (GDD) revisions exhibited more vision-threatening conditions than glaucoma drainage devices (p = 0.037 and p = 0.010 respectively). Ophthalmology consultation was sought for 88.0% of ocular diagnoses. Most received medical therapy (71.0%), primarily IOP-lowering drops. ConclusionED visits after glaucoma surgery are infrequent, yet more often seen in younger patients or those undergoing their first glaucoma surgery. TMBS, but not trabecular meshwork excision and/or Schlemm’s canal dilation (TME/SCD), were less likely to present to the ED than traditional surgeries. Filtering surgeries and tube revisions presented more often with visual threatening conditions.

Télé-expertise en ophtalmologie au centre hospitalier universitaire de Rennes : évaluation de la plateforme sécurisée OMNIDOC au cours de sa première année d’utilisation

Ophthalmology as a specialty is a pioneer in the area of telemedicine. Remote consultation represents one of the 5 types of telemedicine services, with a growing volume of activity in university hospitals. In November 2020, the ophthalmology department of Rennes University Medical Center launched its remote consultation network with the secured platform OMNIDOC. The goal of this study was to assess its contribution during its first year of use. Beginning in November 2020, ophthalmology consults at Rennes University Medical Center were directed towards the dedicated OMNIDOC network. Three-hundred and forty-one requests for remote consultation were received and analyzed between November 2020 and October 2021. We sent a satisfaction survey to both the requesting and consultant physicians to assess whether or not the network was beneficial. Three-hundred and twenty-seven remote consultations requested by 126 practitioners were included in the study. The median response time was 6hours. Every field of the specialty was involved, of which 22.3% were for pediatric patients under 6years of age. Among the requests, 89.7% were regional (Brittany) and came mostly from ophthalmologists (61.77%). Nearly one out of two patients did not require an in-person consultation at Rennes University Medical Center. The implementation of a remote consultation network allowed access to a rapid, facilitated medical ophthalmology consultation. Such a platform delivers safety and traceability of the interactions. It enhances and optimizes the patients' care pathway and encourages relationships with community physicians.

Impact of 5 waves of COVID-19 on pediatric ophthalmology

ObjectiveTo characterize the impact of multiple waves of COVID-19 on pediatric ophthalmology at a tertiary care hospital. MethodsMedical records were reviewed from pediatric patients seen for ophthalmic emergencies at the Montreal Children's Hospital (Montreal, Canada) from 5 COVID-19 periods: March 13 to May 31, 2020; September 20, 2020, to February 21, 2021; March 21 to May 31, 2021; August 17 to November 5, 2021; and December 19, 2021, to January 25, 2022, as well as 2 pre-COVID time periods: March 13 to May 31, in 2018 and 2019). ResultsThere was a significant reduction in ophthalmic consultations when comparing pre-COVID to all 5 COVID waves (p < 0.0001). There was an increase in the average number of daily urgent (p = 0.01) ophthalmic consultations from waves 1 to 4. Mean household income of patients was not significantly different pre-COVID compared to during the 5 COVID waves (p = 0.96). The most common referral reason was ocular trauma (38.0% of cases). There was a non-significant trend demonstrating more infectious disease presentations during waves 3 to 5 (p = 0.07). There was no difference in symptom duration prior to presentation (p = 0.54); however, there was a difference in the time between emergency room and ophthalmology assessment in waves 3 and 4 compared with wave 5 (p = 0.003). ConclusionThe number of pediatric ophthalmology consultations was less during the 5 COVID waves than pre-COVID. An increase in urgent pediatric ophthalmology consultations occurred as COVID-19 infection rates in Quebec decreased. Access to health care and time to care were preserved across waves compared with pre-pandemic.

Perception and practices of obstetricians and ophthalmologists eye diseases during pregnancy

Aims: Cesarean delivery can be crucial for both the mother and the baby, with indications often stemming from fetal or maternal health concerns. In addition to obstetric factors, non-obstetric conditions such as eye diseases frequently necessitate cesarean delivery. Among the eye diseases commonly encountered during pregnancy are refractive errors, diabetic retinopathy, ocular malignancies, and glaucoma. Some of these conditions may exacerbate during pregnancy due to related health issues like diabetes or hypertension, or they may be aggravated by the stress of vaginal labor. Consequently, the decision regarding the continuation of pregnancy, the mode of delivery, and even the choice of anesthesia can vary depending on the specific eye disease and its severity or characteristics. The aim of this study was to assess the knowledge and attitudes of obstetricians regarding the management of pregnant women with different eye conditions, with the ultimate goal of increasing awareness among obstetricians. Methods: In this study, a total of 46 obstetricians and 30 ophthalmologists practicing in Turkiye were included. Participants were surveyed to gather information, as no existing survey or scale pertaining to our study subject was available. Therefore, a novel survey form was developed based on previous studies addressing similar topics, and this survey was administered to all participants. Results: During the study, both obstetricians and ophthalmologists were queried about the management of 17 distinct eye diseases occurring during pregnancy. Ophthalmologists advocated for normal vaginal delivery (NVD) in 13 out of the 17 eye diseases. On the other hand, obstetricians opted for NVD in 5 out of the 17 cases, while recommending ophthalmology consultation in 12 out of the 17 scenarios. Conclusion: It has been noted that ophthalmologists suggest vaginal birth in 9 out of 17 eye diseases, whereas obstetricians tend to recommend consulting ophthalmologists rather than making independent decisions. This trend may stem from the fact that obstetricians may lack sufficient knowledge about eye diseases, as these conditions are not primarily within the scope of pregnancy-related care. Additionally, obstetricians might be inclined to share responsibility, possibly due to the rise in malpractice cases against obstetricians in recent years in Turkiye.

The carbon footprint of French hospital ophthalmology consultations.

France carbon footprint, with 604 million tons of CO2 equivalent (CO2eq) annual emissions, far exceeds the worldwide scientific specifications to not exceed 2 °C of warming in 2100. The healthcare sector is one of the biggest contributors to greenhouse gas emissions. The aim of this study is to quantify and evaluate the carbon footprint of the consultation activity of an ophthalmology department at a single institution in France. The perimeter of the investigation included consultations and excluded the surgeries and the hospitalisation. We calculated the carbon footprint of a single day of practice in our scope of investigation. We included consumption of energy, patient travel, staff travel, pharmaceutics and medical devices purchases, computer hardware, biomedical equipment/exam materials, and waste. We used the official French public database of emission factors: Base Empreinte® of the Environmental and Energy Management Agency of France. The carbon footprint of a single day of our department was estimated at 1 688.65 kgCO2eq. It represents an average of 9.28 kgCO2eq per patient. Energy consumption contributed for 114.80 kgCO2eq (6.8%), travel for 1324.76 kgCO2eq (78.4%), pharmaceutics and medical devices for 208.33 kgCO2eq (12.3%), equipment for 14.38 kgCO2eq (0.9%) and waste for 26.38 kgCO2eq (1.6%). This study highlights the importance of patient travels, and possibly pharmaceutics, in the carbon footprint of hospital ophthalmology practice in France. More studies are needed to establish it at the national or international scale, as well as more carbon footprint analyses on products, especially those of high prices, to increase the accuracy of these studies.

Ocular Manifestations and Complications of Patent Foramen Ovale: A Narrative Review.

Patent foramen ovale (PFO) is a prevalent congenital cardiac anomaly associated with a persistent opening between the atrial septum, allowing communication between the left and right atria. Despite often being asymptomatic, PFO can lead to various clinical presentations, including cryptogenic stroke and other embolic events. Transient visual disturbances, alterations in the visual field, migraine with aura, impaired eye movement and endogenous eye infections may prompt patients to seek ophthalmological consultation. Understanding these diverse clinical scenarios is crucial for early detection, appropriate management and mitigating the morbidity burden associated with PFO. This narrative review aims at examining the spectrum of clinical presentations of ocular pictures associated with PFO. The pathophysiology, diagnosis and treatment methods for PFO will be described, emphasizing the importance of a multidisciplinary approach involving ophthalmologists, cardiologists, neurologists and imaging specialists. In the future, prospective studies and clinical trials are warranted to provide further insights into the preventive role and optimal therapeutic strategies for managing PFO-related ocular complications, ultimately guiding clinical decision making and optimizing patient care.

764 Burn Advanced Practice Provider Fluorescein Dye Staining Reduces Ophthalmology Consults

Abstract Introduction Facial burn injury patients typically receive ophthalmology consultations irrespective of the severity of their peri-ocular or ocular involvement. Minor facial burns without significant eye involvement or ocular complaints often do not require in-patient ophthalmologist assessment. We sought to assess ocular fluorescein dye staining by burn unit Advanced Practice Providers (APP; Physician Assistants and Nurse Practitioners) to decrease unnecessary ophthalmology consults. Methods A prospective evaluation was performed at our ABA-verified burn center for all facial burn injury patients admitted between January 1 through August 31, 2023. Patients who presented with full-thickness injuries to their eyelids or peri-ocular area, those exhibiting tense eyelids raising concern for ocular compartment syndrome, those with severe eye pain and anyone with acute vision loss were excluded from staining and received an immediate ophthalmology consult. For patients with facial burns who did not meet the aforementioned criteria, fluorescein dye stains were administered upon admission by APPs, if available. Ophthalmology consults were only ordered for patients with positive stains. Results 83 patients were admitted with facial burns between January 1 and August 31, 2023. Of these, 42 patients received fluorescein dye stains by APPs. Among those stained, 79% were male and 21% female. The average age was 49 years old (range 19 to 82). The average TBSA affected was 8.46% (range 0.1% to 38.5%). The majority of patients (83%) had flame/flash burns, 7% had scald burns, 2% had chemical burns, 2% had sun burns and the remainder had unclear etiology. 34 patient dye stains (80%) yielded negative results, obviating the need for an ophthalmology consult. The remaining 8 had positive results, necessitating a consult. Among these, 4 were false positives with no ocular injury found by ophthalmology. The remaining 4 exhibited ocular chemosis, trace punctate epithelial erosions, thermal keratopathy and chronic central epithelial defects from prior Lasik surgery. Ophthalmology was consulted in 37 out of 83 patients, with only 8 consults resulting from APP staining. This signifies a 48% overall reduction in consults placed during this 8-month time frame, and an 80% reduction of consults in whom qualified for the pathway. Conclusions Fluorescein dye staining by burn unit APPs minimizes unnecessary ophthalmology consults, likely reducing healthcare costs for patients and healthcare facilities. Applicability of Research to Practice Burn centers should consider fluorescein dye stain screening as part of routine practice for burn patients.

Multicenter Study of the Effectiveness of Antifungal Stewardship Team Intervention for Candidemia in Japan in 2008-2021.

Candidemia, linked to high mortality rates, requires prompt antifungal therapy for better outcomes. Treatment is structured as an action bundle, which is beneficial when followed closely. However, the Japanese action bundle lacks detailed guidance on severe complications like endocarditis or ocular issues. To address this, we adjusted the action bundle and assessed outcomes with and without AFT intervention. We strengthened protocols for blood cultures and organ assessments, and the AFT contacted the primary physician when yeast-like fungi were detected in the patient's blood culture bottles. Analyzing 204 candidemia cases from 2008-2021, we observed increased adherence and reduced mortality post-AFT intervention. Ophthalmology consultations rose significantly, but many patients had only one visit, suggesting inadequate follow-up. If endophthalmitis is diagnosed, a change in the treatment approach may be necessary. There is a possibility that abnormal ocular findings will be detected during subsequent visits, which highlights the need for improvement in ophthalmology follow-up rates as a future challenge for our AFT activities.

Ocular Trauma Characterization in a Reference Emergency Eye Centre in Colombia (FOSCAL).

Ocular trauma is one of the most important causes of ocular morbidity and inadequate visual acuity in developed and developing countries. In some countries, eye trauma is the leading cause of monocular blindness. Studies conducted in developing countries like Colombia suggest that there is a lack of awareness of preventive measures. In Colombia, there is no countrywide ocular trauma registry. The purpose of the present study is to describe and analyse characteristics of ocular trauma at a tertiary ophthalmology emergency department in Colombia. Patients who consulted or were referred to the ophthalmologic emergency department of FOSCAL due to eye injuries between March 1, 2022, and January 10, 2023, were included in this cross-sectional study. Of 1 957 patients, 2 088 eyes were included. Men comprised 78.5% of the patients, the median age was 36 years, and 75.0% lived in urban areas. The median latency between trauma and ophthalmology consultation was 21.8 hours. Of the eyes, 1 805 (88.4%) had suffered mechanical or mixed (mechanical plus burn) trauma. Of the injuries, 87.5% were unilateral. In terms of the circumstances, 45.9% of injuries occurred during working or educational activities (in 85.6% of these cases, without eye protection), 28.2% in home accidents, and 14.0% in transportation situations. According to the Birmingham Eye Trauma Terminology System (BETT), 1 735 eyes (91.1%) were closed globe injuries, and 49 eyes (2.7%) were open globe injuries. Fifty eyes (2.8%) could not be categorised according to BETT at the initial consultation and were classified as "still to be determined". In the Ocular Trauma Score (OTS), 85.8% were category 5. Of the ocular burn cases, 93.0% were categorised as grade I according to the Roper Hall classification. In line with global literature, a much higher proportion of men than women sought consultation for ocular trauma. The findings suggest a need for improvement in the referral process from institutions with the lowest level of care. Lack of awareness about eye protection is an issue. Surgical exploration or additional tests may be necessary for precise injury classification. We therefore propose adding a "still to be determined" category to the BETT initial classification. These cases may be reclassified later, thus improving the accuracy of OTS calculation.