Ophthalmology Setting Research Articles

Accuracy of Ophthalmology Clinic Follow-Up in the Incarcerated Patient Population

Abstract Purpose Incarcerated patients represent a uniquely vulnerable population in the outpatient ophthalmology setting, and the reliability of follow-up in this group is undetermined. Methods This was a retrospective, observational chart review of consecutive incarcerated patients evaluated at the ophthalmology clinic of a single academic medical center between July 2012 and September 2016. For each encounter the following were recorded: patient age, gender, incarcerated status at the time of encounter (a subset of patients had encounters before/after incarceration), interventions performed, follow-up interval requested, urgency of follow-up, and actual time to subsequent follow-up. Primary outcome measures were no-show rate and timeliness, which was defined as follow-up within 1.5× the requested period. Results There were 489 patients included during the study period, representing a total of 2,014 clinical encounters. Of the 489 patients, 189 (38.7%) were seen once. Of the remaining 300 patients with more than one encounter, 184 (61.3%) ultimately did not return and only 24 (8%) were always on time for every encounter. Of 1,747 encounters with specific follow-up requested, 1,072 were considered timely (61.3%). Factors significantly associated with subsequent loss to follow-up include whether a procedure was performed (p < 0.0001), urgency of follow-up (p < 0.0001), incarcerated status (p = 0.0408), and whether follow-up was requested (p < 0.0001). Conclusion Almost two-thirds of incarcerated patients in our population requiring repeat examination were lost to follow-up, particularly those who underwent an intervention or required more urgent follow-up. Patients entering and exiting the penal system were less likely to follow-up while incarcerated. Further work is needed to understand how these gaps compare to those in the general population and to identify means of improving these outcomes.

Clinical profile and outcome of ocular manifestation in Marfans syndrome in India.

Purpose:Marfan syndrome (MFS) is a genetic disorder associated with considerable morbidity and mortality. Presently, well-documented information on this condition is not available in India.Methods:In this retrospective cohort study, we recruited patients with clinically diagnosed MFS who presented to the outpatient department using revised Ghent nosology. We retrieved complete ophthalmic information, including vision, anterior and posterior segments, exported from electronic medical records, and relevant investigations, surgical details, and follow-up data were obtained in a specific, pretested format.Results:Our cohort consisted of 86 eyes of 43 patients and had a male preponderance. The prevalence was 20.5 per 100,000 individuals. The mean age of the patients was 23.9 years. All eyes were treated either optically with refraction or surgically using lensectomy and vitrectomy with suture supported scleral fixated intraocular lens (IOL), which significantly affected the visual outcome (P = 0.000).Conclusion:Although considered a rare disease, MFS is commonly found in the ophthalmological setting. Refraction and surgery (lensectomy with scleral fixated IOL) may improve the vision significantly.

Assessing the efficacy of 3D-printed ear protectors on mask adherence at an academic ophthalmology center.

Purpose:In the ophthalmology setting, given the close proximity required for the clinical exam, appropriate mask usage and fit is essential. This study aims to assess how a simple, cost-effective 3D-printed face mask ear protectors (EP) attachment may decrease discomfort, increase compliance, and improve fit in an academic institution’s Ophthalmology department.Methods:Face mask EPs were distributed to patients and providers in the Ophthalmology department. A validated questionnaire was administered before and 2 weeks after EP usage. The survey included questions on demographics and frequency of mask usage during a spectrum of activities. Descriptive statistics were performed with Fischer’s t test.Results:Post-EP responses demonstrated an increased likelihood of mask usage across all activities, although not statistically significant. The greatest change was during outdoor activities, with a 14.3% increase in highest utilization. Post-EP, all subjects were very likely to wear masks while shopping and 91.7% while in the workplace. EP usage decreased the number of noncompliant individuals while spending time with friends and family by 93.3%. Almost no subjects reported mask removal of >15 times per hour post-EP. The increase in mask compliance was greatest for low mask utilizers. 91.9% reported improved comfort, 91.9% reported improved fit, and 81.6% reported increased mask usage.Conclusion:Our results suggest that simple cost-effective 3D-printed ear protectors may improve fit, comfort, and overall mask compliance. The results of this study should drive broader public health efforts to further investigate whether mask attachments can improve overall mask compliance through better comfort and fit.

Presentation of sclerouveitis with features of Vogt Koyanagi Harada syndrome and ocular tuberculosis – A Rare Combination

Inflammation of sclera with involvement of uvea is an uncommon and underdiagnosed disease entity seen in an ophthalmological outpatient setting. A 34-year-old male presented with complaints of headache, redness, pain, photophobia, and blurring of vision in the left eye > right eye with associated tinnitus, decreased hearing, and recurrent severe headaches over 3 months. Detailed ophthalmological examination revealed signs of sclerouveitis. We thoroughly investigated the patient which revealed manifestations of incomplete VKH syndrome, along with strongly positive mantoux test hence, he was started on oral steroids under antituberculous treatment cover after physician consult. On follow-up, the patient was symptomatically better with resolution of inflammatory signs over a period of 3 months. The patient is being followed up by multispecialty approach to discern VKH manifestations of later disease.

Prevalence, indications and demographic characteristics of Botulinum neurotoxin use in a tertiary oculoplastic centre.

Over the past 40 years, Botulinum Neurotoxin (BoNT) treatment has been used in many presentations to the hospital eye service. There is little published on its practice in an ophthalmology setting. We aim to report on the prevalence of BoNT use, indications for treatment, age, gender, socioeconomic and ethnic variations observed, and dosages used. We performed a retrospective cross sectional observation study on the use of botulinum neurotoxin treatment in the oculoplastic department of a busy tertiary centre in the University Hospitals of Leicester, United Kingdom. The prevalence of BoNT in the service was 13.7 per 100,000 people. Of the 145 cases identified, the commonest indications for treatment were hemifacial spasm (62% of cases) and blepharospasm (29% of cases). Proportionally, twice as many females than males received BoNT (χ2 = 17.3, p < 0.0001). For those >30 years of age, the prevalence increased with age with those >90 years having a seven times higher prevalence than the mean. Overall, no significant differences were found in ethnicity and median index of multiple deprivation rank between those with treatment and the general population although specific district council variations were noted. These findings would assist commissioners in providing adequate resources to meet demand based on the demographics of their local population. Further qualitative and quantitative research is required to enhance our understanding of some of these trends.

Evaluation of the Effectiveness of Ophthalmology Emergency Clinic Intake Forms

Objective: To evaluate the effectiveness of a novel patient intake form in an emergency ophthalmology clinic at a Canadian academic center. Despite the popularity of intake forms, they have not been previously reported in the literature in an emergency ophthalmology clinic setting.&#x0D; Methods: All new patients at the University of Ottawa emergency ophthalmology clinic were provided with a patient intake form to complete while waiting to be seen. Ophthalmology residents and nurses at the University of Ottawa completed an effectiveness survey evaluating the benefits of these forms after 24 months of use. Emergency ophthalmology clinics at other Canadian academic institutions were questioned regarding their use of patient intake forms. &#x0D; Results: Nine residents and two nurses completed the effectiveness survey. The mean (SD) score assessing the use of the form (1=never, 5=every patient encounter) was 3.90 (1.20). The greatest perceived benefit involved improved clinic efficiency (91%). All (100%) of responses indicated that the form should continue to be used in practice. Of the other 14 ophthalmology residency programs in Canada, nine currently do not use an intake form, two have forms completed by nurses and three utilize a form but are dissatisfied with their results.&#x0D; Conclusions: Our results suggest that there are benefits with respect to clinic efficiency, accuracy of medical information, collaboration between healthcare professionals, and patient satisfaction when utilizing patient intake forms in an emergency ophthalmology setting. The use of similar forms may provide an opportunity to improve clinical practice at other academic institutions within Canada.

Effectiveness of a 3D-printed mask fitter in an Ophthalmology setting during COVID-19

ObjectiveTo assess the effectiveness of a 3D-printed custom mask fitter in lieu of N95 respirators among ophthalmologists and other eye care professionals who may not be prioritized to receive N95 respirators amidst the coronavirus disease 2019 pandemic. MethodsThis was a proof-of-concept study from a tertiary eye care center in Oakville, Canada. All participants underwent the N95 Qualitative Fit Test with a custom mask fitter secured over an American Society for Testing and Materials Level 3 face mask. Participants answered a 10-point Likert scale questionnaire on comfort, ease of use, and feasibility of the custom mask fitter, as well as comfort of a regular face mask. ResultsTwenty participants were recruited. Of the 20 recruited, 18 (90%) successfully passed the fit test. The median scores for comfort, ease of use, and everyday feasibility for the custom mask fitter were 3.5, 4.5, and 3, respectively, whereas the median score for comfort of a regular face mask was 8.5. ConclusionA reusable, low-cost, 3D-printed custom mask fitter is a potential effective alternative to an N95 respirator among eye care professionals but may require improvement in its design and comfort. This is especially relevant in the context of a limited supply of N95 respirators amidst a global pandemic.

Assessing the Clinical Utility of Point of Care HbA1c in the Ophthalmology Outpatient Setting.

Background/AimsEffective management of diabetic retinopathy requires multidisciplinary input. We aimed to evaluate the impact of point of care (POC) HbA1c testing as a tool to identify patients most in need of specialist diabetologist input and assess the accuracy and determinants of patients’ insight into their glycaemic and blood pressure control.MethodsForty-nine patients with diabetic retinopathy were recruited from the eye clinic at Great Western Hospital. Patients completed a questionnaire and POC HbA1c and blood pressure values were measured. Statistical analysis was completed with SPSS v23.ResultsMean age was 64.4 years, median interval since the last formal HbA1c reading was 10.2 months and the mean POC HbA1c was 64.1 mmol/mol. HbA1c significantly correlated with the degree of retinopathy. Of the patients, 81.6% had POC readings above the levels recommended by the National Institute for Health and Care Excellence, with only 16.3% having insight into this. Insight to HbA1c levels was predicted by age but not by duration of disease. Fourteen patients (33.3%) identified with high HbA1c readings were referred to secondary diabetic services and 88.8% of patients felt that the test was useful and likely to improve their diabetic control.ConclusionThe majority of patients had poor insight into their diabetes control, with sub-optimal treatment and follow-up. Poor insight is high in younger patients, suggesting that POC HbA1c testing is particularly important in educating younger patients who may be Type 1 diabetics with more severe disease. POC HbA1c represents a cost-effective, reproducible and clinically significant tool for the management of diabetes in an outpatient ophthalmology setting, allowing the rapid recognition of high-risk patients and appropriate referral to secondary diabetic services.

A novel indigenous technique for corneal tattooing using self-prepared do-it-yourself carbon soot pigment.

Purpose:To evaluate the cosmetic efficacy and safety of an indigenous novel corneal tattooing technique using a self-prepared candle soot pigment.Methods:This pilot observational study involved 22 eyes of patients at a Bengaluru-based ophthalmology setting. The study considered only eyes with nil or low visual potential. Eyes with active ocular inflammation, nasolacrimal obstruction, severe hypotony, and shrunken globe due to phthisis bulbi were excluded. The surgery was carried out under aseptic conditions using a self-prepared carbon soot pigment. Different methods such as lamellar, surface needle micropuncture, machine-assisted surface tattooing, or a combination were used for pigment application.Results:Ten eyes underwent combined lamellar and surface tattooing; lamellar tattooing was performed for 11 eyes, and surface tattooing for one eye. Nineteen patients underwent limbus-to-limbus corneal tattooing and three patients had undergone focal tattooing to cover nasal pterygium scar, inferior iridectomy, and leukocoria due to calcific cataract. Nearly 91% were subjectively satisfied with the tattooing technique and 82% had excellent cosmetic coverage along with subjective satisfaction. None of the subjects required a repeat surgery or augmentation of tattooing. There was no reported case of corneal inflammation, epithelial erosions, infiltrations, infections, nonhealing areas, stromal melting, or any other complications.Conclusion:This novel procedure, involving self-prepared carbon soot pigment tattooing, provides excellent cosmetic results and high patient satisfaction. It is relatively safe, easy to perform, and the conventional steps of tattooing such as pigment procurement, storage, and sterilization can be avoided, as the carbon pigment is freshly prepared under aseptic conditions.

Bacterial Cross-Contamination in a Veterinary Ophthalmology Setting.

The present study describes the prevalence of bacterial cross-contamination in a veterinary ophthalmology setting, a serious issue that can result in healthcare-associated (or nosocomial) infections among patients and staff. Retrospective (n = 5 patients) and prospective (n = 23 patients) studies evaluated bacterial isolates in companion animals presenting with ulcerative keratitis, sampling the patients' cornea and surrounding examination room, including the environment (exam table, countertop, floor) and ophthalmic equipment (slit lamp, transilluminator, direct ophthalmoscope, indirect headset, tonometer). Results of bacterial culture and antibiotic susceptibility testing were recorded, and degree of genetic relatedness was evaluated in six pairs of isolates (cornea + environment or equipment) using pulse-field gel electrophoresis (PFGE). Overall contamination rate of ophthalmic equipment, environment, and examination rooms (equipment + environment) was 42.9% (15/35 samples), 23.7% (9/38 samples) and 32.9% (24/73 samples), respectively. Methicillin-resistant Staphylococcus pseudintermedius (MRSP), a multi-drug resistant (MDR) pathogen with zoonotic potential, was isolated in 8.2% (6/73) of samples. The patient's cornea was likely the source of cross-contamination in 50% (3/6) of MRSP pairs as evaluated by PFGE; notably, two of the three similar bacterial strains did not have an exact match of their antibiotic susceptibility profiles, highlighting the importance of advanced diagnostics such as PFGE to assess cross-contamination in healthcare facilities. Future work could examine the contamination prevalence of specific equipment or the efficacy of cleaning protocols to mitigate cross-contamination in veterinary practice.

Quantitative measures of corneal transparency, derived from objective analysis of depth-resolved corneal images, demonstrated with full-field optical coherence tomographic microscopy.

Loss of corneal transparency, as occurs with various pathologies, infections, immune reactions, trauma, aging, and surgery, is a major cause of visual handicap worldwide. However, current means to assess corneal transparency are extremely limited and clinical and eye-bank practice usually involve a subjective and qualitative observation of opacities, sometimes with comparison against an arbitrary grading scale, by means of slit-lamp biomicroscopy. Here, we describe a novel objective optical data analysis-based method that enables quantifiable and standardized characterization of corneal transparency from depth-resolved corneal images, addressing the demand for such a means in both the laboratory and clinical ophthalmology setting. Our approach is based on a mathematical analysis of the acquired optical data with respect to the light attenuation from scattering processes in the corneal stroma. Applicable to any depth-resolved corneal imaging modality, it has been validated by means of full-field optical coherence tomographic microscopy (FF-OCT or FF-OCM). Specifically, our results on ex-vivo corneal specimens illustrate that 1) in homogeneous tissues, characterized by an exponential light attenuation with stromal depth (z), the computation of the scattering mean-free path (ls) from the rate of exponential decay allows quantification of the degree of transparency; 2) in heterogeneous tissues, identified by significant deviations from the normal exponential z -profile, a measure of exponential-decay model inadequacy (e.g., by computation of the Birge ratio) allows the estimation of severity of stromal heterogeneity, and the associated depth-dependent variations around the average ls enables precise localization of the pathology.

An eye on hepatitis C: a review.

This review aims to caution ophthalmologists about the ocular consequences leading to the diagnosis of hepatitis C virus infection. In addition, in this context, the effects of old and new drugs are discussed in the ophthalmological setting. The importance of early diagnosis and the curative treatment of the disease has been reported in the national and international literature, demonstrating that its progression has important implications for daily clinical and surgical ophthalmological practice. Despite the scarcity of studies on new direct-acting antiviral drugs, fewer side effects of these drugs have been shown when compared with conventional interferon treatment with or without ribavirin. The ophthalmologist's risk of becoming infected, as demonstrated by the presence of the virus in ocular structures, and the possibility of contamination, is also discussed.

Status of Canadian undergraduate medical education in ophthalmology

ObjectiveTo use the perspectives of undergraduate program directors to assess the current structure and adequacy of undergraduate ophthalmology curricula at Canadian medical schools. DesignCross-sectional survey. ParticipantsUndergraduate ophthalmology program directors at each English-speaking Canadian medical school. MethodsProgram directors were identified and invited to participate in an online survey. The 18-question survey focused on key areas of undergraduate ophthalmology curricula, including length, timeline, setting, and nature of medical students’ exposure to ophthalmology. A period of 4 months was allowed for responses. Information from medical school web sites was combined with survey responses. ResultsResponses were obtained from 7 of the 14 (50%) program directors. All of the respondents represented metropolitan institutions of greater than 100 seats. After combining survey and web site data, only 5 of 14 (35.7%) schools were found to have a mandatory clinical clerkship ophthalmology rotation. In each case, the mandatory rotation is less than 2 weeks. A core curriculum based on the International Council of Ophthalmology (ICO) guidelines is used in only 20% of schools. Extracurricular ophthalmology exposure in the form of research opportunities and interest groups exists in 100% and 71.4% of schools, respectively. ConclusionsThe proportion of schools requiring mandatory clerkship ophthalmology rotations is only 35.7%. However, most departments use strategies to optimize the limited time allotted to ophthalmology rotations during medical school. A greater degree of adherence to the ICO curriculum guidelines may help to ensure that medical students develop an appropriate level of proficiency in managing patients with eye disease.

Stimulus and optode placement effects on functional near-infrared spectroscopy of visual cortex.

Functional near-infrared spectroscopy has yet to be implemented as a stand-alone technique within an ophthalmology clinical setting, despite its promising advantages. The present study aims to further investigate reliability of visual cortical signals. This was achieved by: (1)assessing the effects of optode placements using the 10-20 International System of Electrode Placement consisting of 28 channels, (2)determining effects of stimulus size on response, and (3)evaluating response variability as a result of cap placement across three sessions. Ten participants with mean age [Formula: see text] years (five male) and varying types of hair color and thickness were recruited. Visual stimuli of black-and-white checkerboards, reversing at a frequency of 7.5Hz were presented. Visual angles of individual checker squares included 1deg, 2deg, 5deg, 9deg, and 18deg. The number of channels that showed response was analyzed for each participant, stimulus size, and session. 1-deg stimulus showed the greatest activation. One of three data collection sessions for each participant gave different results ([Formula: see text]). Hair color and thickness each had an effect upon the overall HbO ([Formula: see text]), while only color had a significant effect for HbD ([Formula: see text]). A reliable level of robustness and consistency is still required for clinical implementation and assessment of visual dysfunction.

Ophthalmic referrals from emergency wards—a study of cases referred for urgent eye care (The R.E.S.C.U.E Study)

ObjectiveTo characterize emergency department (ED) referrals in order to identify the most common pathologies, compare accuracy of diagnosis, and measure correlation of visual acuity (VA) and intraocular pressure (IOP) measurements between the ED and ophthalmology setting. Design, Setting, and ParticipantsRetrospective chart review of consecutive patients referred for an ocular emergency after hours to a tertiary care emergency eye clinic in Hamilton, Ontario, between February 17, 2015, and May 3, 2015 (n = 288). MethodsVariables extracted from the patients’ charts included date of referral, age, sex, eye(s) under examination, VA at the time of referral, IOP at the time of the referral, site of referral, the referring physician’s provisional diagnosis, VA at the time of the ophthalmologist consultation, IOP at the time of the ophthalmologist consultation, number of days between referral and ophthalmic consultation, and the ophthalmologist’s diagnosis. ResultsAgreement between ED provisional diagnosis and ophthalmology was good at 79.4% when classified according to anatomic location of pathology. A strong correlation was found between VA measurements in the ED and ophthalmology setting (p < 0.001). IOP measurement was infrequently checked in ED and a significant difference existed between ER physician and ophthalmologist measurements (p = 0.010) where ophthalmology reported lower IOP. ConclusionsThe 5 highest volume diagnoses in descending order were posterior vitreous detachment/vitreous syneresis, corneal abrasion, keratitis, anterior uveitis, and retinal tear/detachment. Visual acuity measurements in ED are reliable. IOP is infrequently checked in the ED and more unreliable when measured over 20 mm Hg.

Comparative evaluation of applanation and indentation tonometers in a community ophthalmology setting in Southern India

PurposeMeasurement of intraocular pressure (IOP) is one of the basic investigations in a general ophthalmic workup. In this study, we attempt to determine the agreement in the measurement of IOP obtained by Perkin’s applanation tonometer, noncontact tonometer and Schiotz indentation tonometer in patients attending general ophthalmology OPD in a tertiary care centre in South India and its use in a community ophthalmology setting. MethodsA cross-sectional analytical study in which IOP was measured in patients using the three tonometers. Central corneal thickness (CCT) was measured using Ultrasonic pachymetry. Bland Altman analysis was done to evaluate the agreement between instruments. Results800 eyes of 400 patients were included in the study. By Bland Altman method, Schiotz indentation tonometer was found to have better correlation to IOP obtained by Perkin’s applanation tonometer. Schiotz indentation tonometer was found to be most accurate when CCT was in the range of 501–550μm and noncontact tonometer was found to be least accurate when CCT was greater than 600 microns. On comparing correlation at different age groups, both the methods had better correlation at <40years age group. ConclusionBoth the tonometers showed a significant correlation with the gold standard technique (Perkin’s applanation tonometer) over a range of IOP and CCT with the Schiotz tonometer better than the NCT. This study proves that Schiotz tonometer can be recommended as a reliable screening tool in community outreach ophthalmology services. The twin advantages of portability and availability make the Schiotz tonometer a popular choice among ophthalmology trainees and optometrists in a developing country like India.

Clinical pharmacy experience in ophthalmology setting of using collaborative drug therapy management (CDTM)

BackgroundAn increased influx of patients and limited access to specialised healthcare due to insufficient medical staff in ophthalmology has been reported for more than a decade. For this reason, our...

High Diagnostic Yield of Whole Exome Sequencing in Participants With Retinal Dystrophies in a Clinical Ophthalmology Setting

To assess the diagnostic yield and the practicality of implementing whole exome sequencing within a clinical ophthalmology setting. Evaluation of a diagnostic protocol. setting: Patient participants were enrolled during clinical appointments in a university-based ophthalmic genetics clinic. Twenty-six patients with a variety of presumed hereditary retinal dystrophies. Participants were offered whole exome sequencing in addition to clinically available sequencing gene panels between July 2012 and January 2013 to determine the molecular etiology of their retinal dystrophy. Diagnostic yield and acceptability of whole exome sequencing in patients with retinal disorders. Twenty-six of 29 eligible patients (∼90%) who were approached opted to undergo molecular testing. Each participant chose whole exome sequencing in addition to, or in lieu of, clinically available sequencing gene panels. Time to obtain informed consent was manageable in the clinical context. Whole exome sequencing successfully identified known pathogenic mutations or suspected deleterious variants in 57.7% of participants. Additionally, 1 participant had 2 autosomal dominant medically actionable incidental findings (unrelated to retinopathy) that were reported to enable the participant to take preventive action and reduce risk for future disease. In this study, we identified the molecular etiology for more than half of all participants. Additionally, we found that participants were widely accepting of whole exome sequencing and the possibility of being informed about medically actionable incidental findings.

Evaluation of ocular hypotensive effects of some drugs used in treatment of open angle glaucoma, at Alsaym Ophthalmic Hospital, Wad Medani, Sudan

Introduction: Glaucoma is a neurodegenerative disease. It is presented by a triad of elevated intraocular pressure (IOP), progressive optic nerve damage, and constriction of the peripheral visual field. Objectives: The aim of this study is to assess the ocular hypotensive effects of some drugs used in treatment of open angle glaucoma (OAG) at Alsaym Ophthalmic Hospital, Wad Medani, Sudan. Methodology: A cross-sectional hospital-based study was conducted at specialized ophthalmological health setting. Patients (n = 200) diagnosed with OAG and treated with different anti-glaucoma drugs were selected randomly to participate in this study. The ocular hypotensive effects of anti-glaucoma drugs were evaluated monthly for 4 successive months, by measuring the diurnal IOP for each patient, using tonometer. The obtained data were collected in especial data collection form and analyzed by IBM SPSS Inc. (IBM SPSS Statistics) Software;Group's Business Analytics Portfolio. Results: Monotherapy of timolol (eye drops 0.5% and 0.1% eye gel), betaxolol 0.5% eye drops produced significant reductions in the total mean of IOP, ranged between 4.4 and 6.1 mmHg, while travoprost 0.004% eye drops showed a remarkable reduction of 7.3 mmHg. Combinations of travoprost with timolol and and/or dorzolamide 2% resulted in significant IOP lowering effects, ranged from 8.9 to 12.7 mmHg. Mono or combined therapy with travoprost was found to be superior to other anti-glaucoma monotherapy. Conclusion: The obtained results showed that travoprost produced clinical significant and superior ocular hypotensive effects when used alone or in combination with timolol and/or dorzolamide. It is thus recommended to use prostaglandin analogues in treatment of OAG because they are the most effective agents in reducing the mean diurnal IOP.

High Diagnostic Yield of Whole Exome Sequencing in Participants With Retinal Dystrophies in a Clinical Ophthalmology Setting

High Diagnostic Yield of Whole Exome Sequencing in Participants With Retinal Dystrophies in a Clinical Ophthalmology Setting