Preferred Practice Pattern Research Articles

Clinical ocular prediction model of postoperative ametropic amblyopia in patients with congenital ectopia lentis.

Despite prompt and appropriate surgical management, a considerable proportion of patients with congenital ectopia lentis (CEL) suffer from postoperative ametropic amblyopia. To predict and identify at-risk patients early, and ensure timely amblyopia treatment, we conducted a thorough investigation into the onset and progression patterns of postoperative amblyopia in patients with CEL. Moreover, an ocular prediction model was constructed for amblyopia. In this prospective cohort study, amblyopia analysis was conducted to reveal the prevalence of postoperative amblyopia at different time points of follow-up. Comparative analysis and logistic regression analysis were performed for the development of an amblyopia prediction model. Receiver Operating Characteristic (ROC) analysis, calibration plots, and decision curve analysis (DCA) were used to evaluate the performance of the model. A nomogram was created to determine the probability of postoperative amblyopia. Amblyopia was diagnosed according to the most recent edition of the Amblyopia Preferred Practice Pattern. A total of 889 eyes from 677 patients operated for CEL were enrolled in this study. In the pediatric cohort, the prevalence of amblyopia showed a decreasing trend with follow-up time from 1 month to 3.5 years. A prediction model based on preoperative best-corrected visual acuity (BCVA) and cardiac phenotype was established to predict postoperative amblyopia. For effective individual prediction, a nomogram was created. With great calibration, discrimination, and clinical usefulness, the prediction model demonstrated good performance. The findings underscore that the prevalence of ametropic amblyopia in pediatric CEL patients who underwent lens surgery exhibited a marked decline over time. The prediction model established with preoperative BCVA and cardiac phenotype can provide accurate and individualized predictions of postoperative amblyopia, and it has the potential to assist ophthalmologists in rapidly identifying high-risk patients.

Preferred practice patterns for safe cataract surgery in the presence of lacrimal and eyelid pathologies

Preferred practice patterns for safe cataract surgery in the presence of lacrimal and eyelid pathologies

Special Commentary: Reporting Clinical Endpoints in Studies of Minimally Invasive Glaucoma Surgery

Minimally invasive glaucoma surgery (MIGS) refers to a group of procedures generally characterized by an ab interno approach, minimal trauma to ocular tissue, moderate efficacy, an excellent safety profile, and rapid recovery. The number of MIGS procedures continues to increase, and their use has become widespread among glaucoma and cataract specialists. Standardization of the methodology and reporting of clinical endpoints in MIGS investigations enhances interpretation and comparison across different studies. The assessment of surgical interventions not only should consider statistical significance, but also whether the outcome is meaningful to patients. Minimal clinically important difference (MCID) is defined as the smallest change in a treatment outcome that is considered beneficial for an individual patient and prompts a change in their clinical management. Expert consensus is an accepted approach to determine the MCID. The American Academy of Ophthalmology's Glaucoma Preferred Practice Pattern® Committee is an expert panel that develops guidelines identifying characteristics and components of quality eye care. The Committee recommends that the cumulative probability of surgical success at 2 years with Kaplan-Meier survival analysis be used as the primary efficacy endpoint in MIGS studies. The Committee suggests that surgical success for standalone MIGS be defined as intraocular pressure (IOP) of 21 mmHg or less and reduced by 20% or more from baseline without an increase in glaucoma medications, additional laser or incisional glaucoma surgery, loss of light perception vision, or hypotony. The proposed MCID for the cumulative probability of success of standalone MIGS at 2 years is 50%. The panel recommends that surgical success for MIGS combined with cataract extraction with intraocular lens implantation (CE-IOL) be defined as a decrease in glaucoma medical therapy of 1 medication or more from baseline without an increase in IOP or IOP of 21 mmHg or less and reduced by 20% or more from baseline without an increase in glaucoma medications, additional laser or incisional glaucoma surgery, loss of light perception vision, or hypotony. The suggested MCID for the cumulative probability of success for MIGS combined with CE-IOL at 2 years is 65%. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Long-Term Prognosis of Anterior Blepharitis After Topical Antibiotics Treatment.

We conducted a retrospective evaluation of the long-term prognosis associated with anterior blepharitis subsequent to topical antibiotic intervention. Inclusion criteria encompassed 92 eyes of 92 patients who exhibited clinical manifestations of anterior blepharitis and undergone a regimen of topical azithromycin. The follow-up duration extended to a minimum of one year within our medical facility. The diagnostic framework for anterior blepharitis, along with the evaluation of both objective and subjective manifestations, adhered to the Blepharitis Preferred Practice Pattern as promulgated by the American Academy of Ophthalmology. Relapse denoted the resurgence of blepharitis symptoms subsequent to the primary treatment, necessitating the instigation of either topical or oral therapeutic measures. Of 92 cases of anterior blepharitis, 48 showed recurrence, with a recurrence rate of 52.2%. During the follow-up period, 2 patients experienced 5 relapses, 2 patients experienced 4 relapses, 5 patients experienced 3 relapses, 13 patients experienced 2 relapses, and 26 patients experienced 1 relapse. When the patients were divided into three groups: multiple recurrence group (22 patients), single recurrence group (26 patients), and no recurrence group (44 patients), there were no significant differences in the blepharitis finding score before and after the initial treatment among three groups. However, significantly fewer patients in the no recurrence group required further treatment after initial treatment, and the percentage of patients with residual blepharitis during follow-up was significantly lower in the no recurrence group. Our data suggest that patients with residual findings after blepharitis treatment are at a risk of recurrence.

Ocular screening for chronic graft-versus-host disease in patients with allogeneic hematopoietic stem cell transplant

ObjectiveThis study investigates ocular manifestations of graft-versus-host disease in patients following allogeneic hematopoietic stem cell transplantation (HSCT) at the University of Texas Medical Branch (UTMB). Preferred practice pattern guidelines are proposed for ocular graft-versus-host disease (oGHVD) detection. MethodsThe Epic electronic medical record database at UTMB was screened using International Classification of Diseases, Tenth Revision (ICD-10), codes for bone marrow transplants, stem cell transplants, and complications of bone marrow transplants and stem cell transplants. We identified 50 patients with the ICD-10 codes that were seen at UTMB between 2000 and 2021. Patients who received an HSCT and follow-up care with UTMB were included in this study. Thirty-eight patients met the inclusion criteria, whereas 12 patients were excluded because they had no diagnosis of HSCT or did not follow-up with UTMB. ResultsOf the 38 patients in our cohort, 23.7% (n = 9) were noted to have oGVHD. As many as 89% of the patients with oGVHD presented with an ocular surface disease including keratoconjunctivitis sicca, meibomian gland dysfunction, and dry eye syndrome. Systemic GVHD also was found in 44% of the patients with oGVHD. Only 29% (n = 11) of the study population had referrals to ophthalmology. Most referrals (55%) were made within 1 year of getting the HSCT. None of the patients in our cohort received an ocular screening before HSCT. ConclusionsMany post-HSCT patients lack routine ophthalmic care. Regularly assessing post-HSCT patients for early signs and symptoms of oGVHD may limit adverse outcomes. Management of oGVHD should involve a multidisciplinary team approach.

Head to head comparison of diagnostic performance of three non-mydriatic cameras for diabetic retinopathy screening with artificial intelligence

BackgroundDiabetic Retinopathy (DR) is a leading cause of blindness worldwide, affecting people with diabetes. The timely diagnosis and treatment of DR are essential in preventing vision loss. Non-mydriatic fundus cameras and artificial intelligence (AI) software have been shown to improve DR screening efficiency. However, few studies have compared the diagnostic performance of different non-mydriatic cameras and AI software.MethodsThis clinical study was conducted at the endocrinology clinic of Akdeniz University with 900 volunteer patients that were previously diagnosed with diabetes but not with diabetic retinopathy. Fundus images of each patient were taken using three non-mydriatic fundus cameras and EyeCheckup AI software was used to diagnose more than mild diabetic retinopathy, vision-threatening diabetic retinopathy, and clinically significant diabetic macular oedema using images from all three cameras. Then patients underwent dilation and 4 wide-field fundus photography. Three retina specialists graded the 4 wide-field fundus images according to the diabetic retinopathy treatment preferred practice patterns of the American Academy of Ophthalmology. The study was pre-registered on clinicaltrials.gov with the ClinicalTrials.gov Identifier: NCT04805541.ResultsThe Canon CR2 AF AF camera had a sensitivity and specificity of 95.65% / 95.92% for diagnosing more than mild DR, the Topcon TRC-NW400 had 95.19% / 96.46%, and the Optomed Aurora had 90.48% / 97.21%. For vision threatening diabetic retinopathy, the Canon CR2 AF had a sensitivity and specificity of 96.00% / 96.34%, the Topcon TRC-NW400 had 98.52% / 95.93%, and the Optomed Aurora had 95.12% / 98.82%. For clinically significant diabetic macular oedema, the Canon CR2 AF had a sensitivity and specificity of 95.83% / 96.83%, the Topcon TRC-NW400 had 98.50% / 96.52%, and the Optomed Aurora had 94.93% / 98.95%.ConclusionThe study demonstrates the potential of using non-mydriatic fundus cameras combined with artificial intelligence software in detecting diabetic retinopathy. Several cameras were tested and, notably, each camera exhibited varying but adequate levels of sensitivity and specificity. The Canon CR2 AF emerged with the highest accuracy in identifying both more than mild diabetic retinopathy and vision-threatening cases, while the Topcon TRC-NW400 excelled in detecting clinically significant diabetic macular oedema. The findings from this study emphasize the importance of considering a non mydriatic camera and artificial intelligence software for diabetic retinopathy screening. However, further research is imperative to explore additional factors influencing the efficiency of diabetic retinopathy screening using AI and non mydriatic cameras such as costs involved and effects of screening using and on an ethnically diverse population.

Artificial intelligence chatbot and Academy Preferred Practice Pattern ® Guidelines on cataract and glaucoma.

Artificial intelligence chatbot and Academy Preferred Practice Pattern ® Guidelines on cataract and glaucoma.

Mydriasis for retinopathy of prematurity screening in Europe: A cross-sectional online survey.

To compile real-time data on the preferred mydriasis practice patterns for retinopathy of prematurity (ROP) screening in Europe. A cross-sectional online survey was conducted from December 2022 to January 2023, using a self-report online questionnaire which was distributed via email to the members of the European Pediatric Ophthalmological Society and the Greek National ROP Task Force. A six-week period of recruitment was determined, and a reminder email was sent after two weeks. Descriptive statistics were used to explore the data, which was summarized with frequencies and percentages. Sixty-six responses were recorded (response rate: 29.5%), representing practices in 55 Neonatal Intensive Care Units from 21 European countries. In 94.5%, the applied mydriatic regimen consists of phenylephrine with at least one muscarinic antagonist, either tropicamide or cyclopentolate. The concentration of phenylephrine ranges from 0.5% to 5%, of tropicamide from 0.25% to 1%, and of cyclopentolate from 0.2% to 1%. The most commonly used regimen (43.6%) contains phenylephrine 2.5% and tropicamide 0.5%, administered either combined or separately. About 54.5% of the reported mydriatic solutions are non-commercial, in-house preparations. Systemic adverse events, including oxygen desaturation, bradycardia and cardiopulmonary arrest were reported in 14.5%. There is considerable heterogeneity in the applied mydriatic regimens for ROP screening in Europe, reflecting the absence of universal guidelines. The wide use of in-house preparations underlines the gap in the pharmaceutical industry. Concern should be raised against the wide use of undiluted commercial drugs, that reach adult dose, in the fragile population of preterm infants.

Geographic Atrophy Management Consensus (GA-MAC): a Delphi panel study on identification, diagnosis and treatment

Background/aimsWith a paradigm shift in geographic atrophy (GA) treatments now available, establishing consensus on the identification and diagnosis of the disease along with considerations for management of patients with GA...

Evaluation of Publications from the American Academy of Ophthalmology: A 5-Year Analysis of Ophthalmology Literature

To analyze recent publications in Ophthalmology, the journal of the American Academy of Ophthalmology. Retrospective review of published articles. No human participants were involved in the study. Articles published in Ophthalmology from January 2018 to December 2022 were reviewed and analyzed. Research and review articles were included and analyzed per the following: total number of published articles based on related subspecialty area, level of evidence using the modified Oxford level of evidence, number of citations, number of listed authors, gender of the corresponding author, country of affiliation of the corresponding and contributing author(s), and involvement of consortium(s), group(s), or committee(s). A total of 965 articles were included. The mean (standard deviation) number of authors per article was 8.6 (5.7) and the majority of corresponding authors were male (665, 70.7%). The greatest number of published articles were related to retina (296, 30.7%) followed by glaucoma (172, 17.8%). The greatest number of Preferred Practice Pattern guidelines were also related to retina (7/24, 29.1%), followed by cornea/dry eye syndrome/external disease (6/24, 25%). Retina (77) had the most level 1 evidence, glaucoma (30) for level 2 evidence, and retina for levels 3 (69) and 4 (65). There were 223 articles contributed by consortia/groups/committees, with most from retina (73, 32.7%) followed by glaucoma (40, 17.9%). The mean number of citations per subspecialty article was highest in retina (45.8/article), followed by uveitis (31.7/article). The United States had the greatest number of affiliated corresponding authors (544, 56.4%), followed by the United Kingdom (68, 7.0%). There were 357 (37.0%) articles with coauthors affiliated outside the corresponding author's country of affiliation, although with a downward trend over the most recent 5-year period. There has been an increasing trend in the number of authors and consortia/group/committee involvement in publications. Although team science and collaborations have increased recently, ongoing efforts to diversify individuals, groups, and subspecialties may be needed. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Retraction: Preferred practice patterns and review on rosacea.

[This corrects the article DOI: 10.4103/IJO.IJO_2983_22].

Retraction: Preferred practice patterns and review on rosacea.

[This corrects the article DOI: 10.4103/IJO.IJO_2983_22].

Preferred Practice Patterns of Congenital Nasolacrimal Duct Obstruction in Jordan.

Congenital nasolacrimal duct obstruction (CNLDO) is fairly common in newborns. The main aim of this cross-sectional study is to assess the preferred practice patterns of CNLDO among ophthalmologists in Jordan. This cross-sectional study was conducted across all ophthalmological practices in Jordan, using convenience sampling. An online questionnaire, designed through Google Forms, was distributed through social media. The survey contained four domains: baseline characteristics of participants and the diagnosis (7 items), medical management (3 items), and surgical management (11 items) of CNLDO. Descriptive statistics were conducted using SPSS (IBM SPSS Corp, SPSS Statistics ver. 26, USA). Eighty-three physicians responded to the survey, with an average age of 40.6 ± 8.6. More than half of the participants (53.0%, n = 44) were general ophthalmologists. Only 37.3% of our sample (n = 31) regularly evaluated the refraction of a child presenting with epiphora suggestive of CNLDO. Criggler's nasolacrimal duct massage was recommended by 62.7% of respondents (n = 52) for up to 12 months. In addition, 72.3% of respondents (n = 60) recommended 12 months as the minimum age for primary probing of CNLDO. Silicon intubation was considered for primary probing starting at 24 months by 31.3% of ophthalmologists (n = 20). Monocanalicular stent was preferred by 42.2% of respondents (n = 27) while 31.3% (n = 20) preferred bicanalicular stent. There is considerable variability in preferred practice patterns regarding the diagnosis and management of CNLDO in Jordan. Our findings highlight the gaps in optimum practices which need to be addressed for better management.

Clinical features of anterior blepharitis after cataract surgery

We evaluated the clinical features of postoperative anterior blepharitis following cataract surgery and the efficacy of topical azithromycin retrospectively. Thirty eyes of 30 patients with a clinical diagnosis of anterior blepharitis by 6 months postoperatively among those who underwent cataract surgery at our institution between November 2020 and June 2022 were included. The diagnosis of anterior blepharitis and the assessment of objective and subjective findings were based on the American Academy of Ophthalmology Blepharitis Preferred Practice Pattern®. Azithromycin eye drops were prescribed for all patients, and findings and symptoms before and after the drops were reviewed. The time of onset ranged from 2 weeks to 6 months after cataract surgery, with the most common onset at 2 to 3 months postoperatively (mean time of onset 79.4 ± 39.6 days). The type of anterior blepharitis was staphylococcal blepharitis in 26 eyes and seborrheic blepharitis in 4 eyes, while mixed type with posterior blepharitis was noted in 6 eyes. Symptoms at the time of examination included irritation (including foreign body sensation) in 24 eyes, tearing in 4 eyes, and redness in 3 eyes. The findings and symptoms of anterior blepharitis were alleviated or resolved with azithromycin eye drops in 26 of the 30 eyes, but the blepharitis recurred in 6 of these eyes, requiring azithromycin eye drops to be re-prescribed. The onset of anterior blepharitis after cataract surgery may be related to a gradual decrease in postoperative eye drops. Patients tended to complain of irritation and foreign body sensation, and azithromycin eye drops were effective in such cases.

Evaporative dry eye disease due to meibomian gland dysfunction: Preferred practice pattern guidelines for diagnosis and treatment.

Evaporative dry eye (EDE) due to meibomian gland dysfunction (MGD) is one of the common clinical problems encountered in ophthalmology. It is a major cause of dry eye disease (DED) and of ocular morbidity. In EDE, inadequate quantity or quality of lipids produced by the meibomian glands leads to faster evaporation of the preocular tear film and symptoms and signs of DED. Although the diagnosis is made using a combination of clinical features and special diagnostic test results, the management of the disease might be challenging as it is often difficult to distinguish EDE from other subtypes of DED. This is critical because the approach to the treatment of DED is guided by identifying the underlying subtype and cause. The traditional treatment of MGD consists of warm compresses, lid massage, and improving lid hygiene, all measures aimed at relieving glandular obstruction and facilitating meibum outflow. In recent years, newer diagnostic imaging modalities and therapies for EDE like vectored thermal pulsation and intense pulsed light therapy have emerged. However, the multitude of management options may confuse the treating ophthalmologist, and a customized rather than a generalized approach is necessary for these patients. This review aims to provide a simplified approach to diagnose EDE due to MGD and to individualize treatment for each patient. The review also emphasizes the role of lifestyle modifications and appropriate counseling so that patients can have realistic expectations and enjoy a better quality of life.

Management of cataract in dry eye disease: Preferred practice pattern guidelines.

Cataract surgery is one of the most commonly performed ophthalmic surgeries in the world. Dry eye disease (DED) is found to coexist in most patients with cataracts due to the overlapping age groups of both these conditions. Preoperative evaluation for DED is important to improve outcomes. A pre-existing DED affecting the tear film is likely to affect biometry. Moreover, special intraoperative considerations are needed in eyes with DED to reduce complications and improve postoperative outcomes. Dry eye disease (DED) is known to occur following an uneventful cataract surgery or a pre-existing DED is likely to worsen following cataract surgery as well. In these situations, despite a good visual outcome, patient dissatisfaction is common owing to the distressing DED symptoms. This review aims to summarize the preoperative, intraoperative, and postoperative considerations when performing cataract surgery in the presence of a coexisting DED.

Systematic analysis of levels of evidence supporting American Academy of Ophthalmology Preferred Practice Pattern guidelines, 2012–2021

BackgroundDespite the increased emphasis on evidence-based medicine, the current state of evidence behind ophthalmology clinical practice guidelines is unknown. The purpose of this systematic analysis was to understand the levels of evidence (LOE) supporting American Academy of Ophthalmology (AAO) Preferred Practice Pattern (PPP) guidelines, assess changes over time, and compare LOE across ophthalmology subspecialties.MethodsAll current PPP guidelines and their immediate predecessors were comprehensively reviewed to identify all recommendations with LOE provided (I [randomized controlled trials], II [case–control or cohort studies], and III [nonanalytic studies]).ResultsTwenty-three out of 24 current PPPs had a prior edition. Among the PPPs with a prior edition, the number of recommendations with LOE decreased from 1254 in prior PPPs to 94 in current PPPs. The number of recommendations with LOE I decreased from 114 to 83, LOE II decreased from 147 to 2, and LOE III decreased from 993 to 9. However, the proportion of LOE I recommendations increased from 9 to 88%, driven by a disproportionate decrease in reporting of evidence lower than LOE I. Subgroup analysis by subspecialty showed similar trends (LOE I recommendations in prior PPPs vs current PPPs: retina: 57 [12%] vs 19 [100%]; cornea: 33 [5%] vs 24 [100%]; glaucoma: 9 [23%] vs 17 [100%]; cataract: 13 [17%] vs 18 [100%]).ConclusionsTrends in LOE reporting in PPP guidelines indicate an increasing emphasis on evidence from randomized controlled trials from 2012 to 2021. The decline in the number of recommendations with LOE reported suggests an area for improvement in future guidelines as the presence of LOE is crucial to facilitate interpretation of clinical practice guidelines.

Financial Disclosures Reported by Industry Among Authors of the American Academy of Ophthalmology Clinical Practice Guidelines

Recommendations of clinical guidelines affect physicians' care delivery. Potential bias and undeclared conflicts of interests (COIs) among guideline authors can impact clinical practice decisions. To assess financial disclosures reported by physician authors of the American Academy of Ophthalmology (AAO) Practice Pattern Guidelines compared with those reported by industry to evaluate the disclosures' accuracy. In this cross-sectional study, all clinical guidelines in the AAO Preferred Practice Patterns (PPP) since 2013 (first year with publicly available industry payment reports) were reviewed on May 1, 2022. Guideline physician authors' name and their reported COI disclosure were extracted from the guideline publication. Payments to physician authors reported by industry were retrieved from the US Centers for Medicare & Medicaid Open Payments database. Physician authors serving on the AAO guideline committee were included. The primary outcome measure was the accuracy of authors' COIs disclosure. Secondary outcome measures were payments to physician authors reported by industry, the types of payments, and authors' gender. A total of 24 AAO guidelines released between 2016 and 2020 were included. Per guideline, there was a mean (SD) of 7.83 (2.24) physician authors. After removing 14 nonphysician authors, 188 physician author names remained, including 83 names assigned as women (44.1%) and 105 names assigned as men (55.9%). Authors could be counted multiple times in these 188 names. According to the Open Payments database, industry reported that 112 of 188 physician authors (59.6%) had at least received 1 payment while serving on the guideline committee, with a payment mean (SD) of $29 849.35 ($54 131.56). According to AAO guidelines, 149 authors (79.3%) had no financial disclosures while serving on the guideline committee. Among these 149 authors, most authors (81 [54.4%]) had payments reported by industry on the Open Payments database not disclosed within the guideline reports. Women physicians were paid significantly more than men for total payments (median [IQR] payments, $15 265 [$598.47-$41 104.67] vs $301.48 [$218.85-$14 615.09]; difference, $14 963.52; P = .003). Industry reported physician guideline authors to have received significant industry payments, some of which were not disclosed within information of the guidelines. To strengthen author transparency regarding these reported disclosures, the authors may want to review and resolve such potential discrepancies during the review and subsequent publication of guidelines.

A view from the clinic - Perspectives from Dutch patients and professionals on high myopia care.

To understand and compare perspectives of patients and professionals on current ophthalmologic care for high myopia, and to identify challenges and future opportunities. Self-reported data were collected through two online questionnaires. Patient perspective was obtained from highly myopic members of a patient organisation based in the Netherlands using a 17-item questionnaire consisting of open and multiple-choice questions regarding personal experience with myopia care. The ophthalmologist perspective was obtained from practising Dutch ophthalmologists with a 12-item questionnaire of multiple-choice questions on work-related demographics, myopia care in daily practice and need for improvement. The response rate for patients was 27% (n= 136/500) and for ophthalmologists, 24% (n= 169/716). Patients were highly concerned about personal progressive loss of vision (69%) and feared their psychological well-being (82%) in case this would happen. The quality of performance of care provided by ophthalmologists was rated as excellent or satisfactory by 64% of the patients. These ratings for multidisciplinary care and insurance reimbursement were as low as 28% and 18% respectively. The mean concern among ophthalmologists about the rise in high myopia was 6.9 (SEM 0.1) on a 10-point scale. Sixty-nine per cent of the ophthalmologists reported that asymptomatic myopic patients should not be examined regularly at outpatient clinics. Ophthalmologists urged the development of clinical guidelines (74%), but did report (95%) that they informed patients about risk factors and complications. This contrasted with the view of patients, of whom 42% were discontent with information provided by ophthalmologists. These questionnaires demonstrated that the current clinical care delivered to highly myopic patients is in need of improvement. The expected higher demand for myopia care in the near future requires preferred practice patterns, professionals specifically trained to manage myopic pathology, accurate and comprehensive information exchange and collaboration of in- and out-of-hospital professionals across the full eye care chain.

Practice patterns and opinions in the treatment of allergic eye disease: A survey among Indian ophthalmologists.

Management of allergic eye disease is seldom straightforward and often challenging. We conducted an online survey to elicit opinions on the preferred practice pattern in the treatment of allergic eye disease. An online survey questionnaire was sent to all practicing ophthalmologists using social media platforms. The respondents were asked about their clinical experience and preferred treatment in various scenarios such as mild-moderate vernal keratoconjunctivitis (VKC), chronic VKC, refractory VKC, steroid responders, giant papillae, and shield ulcer. Respondents were asked about the newer molecule (alcaftadine) and reservations regarding systemic immuno-suppressants and ordering allergy tests in their practice. Ninety - one participants responded to the survey. About 57.1% of ophthalmologists reported coming across more than 10 cases per week in their practice. The most common age group was 5-10 years (61.1%), but adult onset VKC was also reported at 41.6% (1-2 per month), 37.1% (3-5 per month), and 13.5% (more than 10 per month). The disease is perennially present (36.7%), and a mixed form has been reported by 47.8% of ophthalmologists. Dual-acting agents were preferred by 40% in mild-moderate clinical variants. Topical steroids in slow tapering dosage were preferred by 86.7% in their prescription. Tacrolimus 0.03% was preferred by 65.9% and given for at least 3 months of continuous usage by 47.6% of ophthalmologists. High-dose topical steroids were preferred for giant papillae (67.8%) and Shields ulcers (68.3%) in our survey. Supratarsal steroid injection was preferred by 50% in treating refractory VKC in our survey. Allergic eye disease is a common yet annoying disease. The signs and symptoms can vary from subtle, innocuous forms to devastating variants affecting vision and day-to-day work. This survey aims to elicit responses from clinicians spreading across different geographical areas and compares responses based on experience in practice.