Risk Of Visual Loss Research Articles

Clinical and radiological characteristics of odontogenic orbital cellulitis

PurposeTo assess the radiological features and clinical outcomes of odontogenic orbital cellulitis.MethodMulti-centre retrospective study of odontogenic orbital cellulitis. Primary outcomes assessed were causal organism(s), clinical signs, radiological findings, management and visual outcomes.ResultsFour patients with odontogenic orbital cellulitis were identified for inclusion. There was an equal proportion of men and women with a mean age of 43 years (range 25–56 years). All patients presented with an orbital compartment syndrome, with visual acuity of counting fingers (n = 1, 25%), hand movements (n = 1, 25%) and no perception of light (n = 2, 50%). The organisms implicated were Streptococcus milleri (n = 3, 75%) and Streptococcus constellatus (n = 1, 25%). MRI findings showed a subperiosteal abscess was present in all cases, which was characterised radiologically as a T1-hyperintense, T2 minimally hyperintense collection with restricted diffusion and a low apparent diffusion coefficient signal. Final visual acuity ranged from 6/6 to no light perception. One patient required an orbital exenteration due to extensive necrosis with sepsis and systemic deterioration.ConclusionsOdontogenic orbital cellulitis carries a serious risk of vision loss with a propensity to present with an orbital compartment syndrome secondary to Streptococcus species. Outcomes were highly variable, with two cases progressing to blindness of which one required an orbital exenteration.

Understanding Loss to Follow-Up in AMD Patients Receiving VEGF Inhibitor Therapy: Associated Factors and Underlying Reasons.

In patients with wet age-related macular degeneration (AMD), loss to follow-up (LTFU) leads to unplanned interruptions in therapy and the risk of visual loss. This retrospective and prospective case-control cohort study compared AMD patients with (LTFU YES) and without (LTFU NO) LTFU during anti-VEGF treatment over 12 years. LTFU was defined as missing any treatment or monitoring visits, or not scheduling follow-ups for six months. Significant differences between LTFU NO (n = 298) and LTFU YES (n = 174) groups were age, treatment phase, baseline and final best-corrected visual acuity (BCVA), type of anti-VEGF drug, treatment switch, commuting distance, and escort during commuting. A multivariate logistic regression analysis identified the need for an escort during the commuting and treatment phase as the only significant difference. The four most common reasons for LTFU were general health worsening (21.8%), patient-missed appointments (16.7%), COVID-19-related issues (14.9%), and treatment dissatisfaction (8.6%). The factors associated with increased LTFU rates were older age, inactive treatment phase, lower baseline and final BCVA, bevacizumab treatment, monotherapy, longer travelling distance, and commuting with an escort. According to the multivariate logistic regression analysis, only the escort during the commuting and treatment phases was significant. These findings could direct research to explore social support in treatment adherence and highlight the importance of treatment phases in practice.

Federated Learning for Diabetic Retinopathy Detection Using Vision Transformers

A common consequence of diabetes mellitus called diabetic retinopathy (DR) results in lesions on the retina that impair vision. It can cause blindness if not detected in time. Unfortunately, DR cannot be reversed, and treatment simply keeps eyesight intact. The risk of vision loss can be considerably decreased with early detection and treatment of DR. Ophtalmologists must manually diagnose DR retinal fundus images, which takes time, effort, and is cost-consuming. It is also more prone to error than computer-aided diagnosis methods. Deep learning has recently become one of the methods used most frequently to improve performance in a variety of fields, including medical image analysis and classification. In this paper, we develop a federated learning approach to detect diabetic retinopathy using four distributed institutions in order to build a robust model. Our federated learning approach is based on Vision Transformer architecture to classify DR and Normal cases. Several performance measures were used such as accuracy, area under the curve (AUC), sensitivity and specificity. The results show an improvement of up to 3% in terms of accuracy with the proposed federated learning technique. The technique also resolving crucial issues like data security, data access rights, and data protection.

Does Adjuvant Gamma Knife Stereotactic Radiosurgery Have a Role in Treating Optic Nerve Sheath Meningiomas?

Meningiomas arising from or adjacent to the optic nerve sheath meningioma (ONSM) are management challenges because of their risk of visual loss. Stereotactic radiosurgery (SRS) is a minimally invasive modality that can be added as adjuvant treatment for patients whose tumor has progressed or recurred after initial resection. The authors retrospectively reviewed 2,030 meningioma patients who underwent SRS between 1987 and 2022. In total, 7 patients (4 females; median age = 49) were found with tumors originating from the optic nerve sheath. None of the patients had tumors that engulfed the optic nerve as such tumors typically undergo fractionated radiation therapy (FRT) to preserve vision. The clinical history, visual function, and radiographic and neurological findings were characterized. Outcome measures included visual status, tumor control, and the need for additional management. All patients underwent either initial gross total (n = 1) or partial surgical resection (n = 6) before SRS. Two patients with progressive tumor growth also had SRS after failing additional fractionated radiation after surgery (54 Gy, 30 fractions for both patients). The median time between the date of surgery and the SRS procedure date was 38 months. The Leksell Gamma Knife was used to deliver a margin dose of 12 Gy (range: 8-14 Gy) to a median cumulative tumor volume of 3.3 cc (range: 1.2-18 cc). The median maximal optic nerve radiation dose was 6.5 Gy (range: 1.9-8.1 Gy). After SRS, the median follow-up time was 130 months (range: 26-169 months). Two patients showed local tumor progression at 20 and 55 months after SRS. Four had stable visual function, 2 experienced improved visual acuity, and 1 patient had visual deterioration. Meningiomas arising from (but not engulfing the optic nerve) represent management quandaries after failed initial surgical removal. In this experience, salvage SRS was associated with tumor control and vision preservation in 5 of 7 patients. Additional experience with this strategy may further define the role of SRS both as a salvage and primary option.

Dietary habits and dietary nutrient intake in patients with age-related macular degeneration: A case-control study.

Age-related macular degeneration (AMD) is the leading cause of irreversible blindness among older adults in developed countries. Although many risk factors are known, the pathogenesis of AMD is still unclear. However, oxidative stress probably plays a vital role in the process of AMD. The increasing prevalence of AMD, risk of vision loss, limited treatment of dry form, expensive treatment of wet form, and decreased quality of life are factors that lead to considering modifiable risk factors of AMD, such as nutrition. This is the first study describing the relationship between dietary habits, dietary nutrient intake and AMD in the Czech Republic. In this research, a total of 93 cases with AMD and 58 controls without AMD and cataracts participated. All participants were ophthalmologically examined at the Clinic of Eye Treatments at the University Hospital Brno. Data were collected using a pre-tested self-report questionnaire in a face-to-face interview. Food consumption frequency was assessed by an 18-item semiquantitative food-frequency questionnaire (FFQ). Dietary nutrient intakes were calculated from a 24-hour recall. Patients with AMD compared with controls had significantly higher consumption of legumes and lower consumption of meat products, salt and salty products. In men, we found statistically significant differences in alcohol consumption. The case group consumed alcoholic beverages more frequently (median: 2 times a week) than the control group (median: 1-3 times a month). No differences in alcohol consumption were found in women. In comparison to the case group, the control group had a significantly higher dietary intake of energy (5,783.8 vs. 4,849.3 kJ/day; p = 0.002), proteins (65.3 vs. 52.3 g/day; p = 0.002), fats (57.6 vs. 49.4 g/day; p = 0.046), saturated fatty acids (21.7 vs. 18.9 g/day; p = 0.026), carbohydrates (150.4 vs. 127.1 g/day; p = 0.017), dietary fibre (13.2 vs. 11.3 g/day; p = 0.044), vitamin B2 (1.0 vs. 0.9 mg/day; p = 0.029), vitamin B3 (13.9 vs. 10.0 mg/day; p = 0.011), pantothenic acid (3.5 vs. 2.8 mg/day; p = 0.001), vitamin B6 (1.3 vs. 1.0 mg/day; p = 0.001), potassium (1,656.5 vs. 1,418.0 mg/day; p = 0.022), phosphorus (845.4 vs. 718.7 mg/day; p = 0.020), magnesium (176.5 vs. 143.0 mg/day; p = 0.012), copper (1.0 vs. 0.8 mg/day; p = 0.011), and zinc (7.1 vs. 6.1 mg/day; p = 0.012) counted from a 24-hour recall. According to FFQ, dietary habits in the patients with AMD and controls were similar. In men from the case group, we found statistically significant higher alcohol consumption. According to a 24-hour recall, the controls achieved recommended dietary intakes rather than cases. In comparison to the case group, the control group had a significantly higher dietary intake of energy, proteins, fats, saturated fatty acids, carbohydrates, dietary fibre, vitamin B2, vitamin B3, pantothenic acid, vitamin B6, potassium, phosphorus, magnesium, copper, and zinc.

The Royal College of Ophthalmologists' National Ophthalmology Database Study of Cataract Surgery: Report 12, Risk factors for suprachoroidal haemorrhage during cataract surgery.

To establish the incidence of acute intraoperative suprachoroidal haemorrhage (AISH) during cataract surgery and identify the risk factors for this complication. Data from the Royal College of Ophthalmologists' National Ophthalmology Database was analysed. During the 11-year study period, from 01/04/2010 to 31/03/2021, 709 083 operations performed on 498 170 patients from 65 centres were eligible for inclusion. AISH occurred in 0.03% (204/709 083, approximately 1 in 3 500) of eligible cataract operations performed during the study period. Posterior capsule rupture was the risk factor most strongly associated with AISH (OR: 17.6, 95% CI: 12.4-24.9, p < 0.001). Other ocular risk factors identified were raised intraocular pressure (IOP) preoperatively (OR: 3.7, 95% CI: 2.5-5.5, p < 0.001), glaucoma (OR: 1.7, 95% CI: 1.2-2.4, p = 0.004). Risk increased with age and patients aged over 90 years were at greatest risk (OR: 6.7, 95% CI: 3.5-12.8, p < 0.001). The addition of intracameral anaesthetic when performing surgery under topical anaesthetic appears to be protective (OR: 0.5, 95% CI: 0.3-0.8, p = 0.003), compared to topical anaesthetic alone. There was a 16-fold increase in the incidence of vision loss when AISH occurred. The risk of AISH during modern cataract surgery is approximately 1 in 3 500 and is associated with a significant increase in the risk of vision loss should it occur. Posterior capsule rupture is the risk factor most strongly associated with AISH. Preoperative IOP control is a modifiable risk factor. The use of intracameral anaesthesia may reduce the risk of AISH.

Suprachoroidal triamcinolone acetonide injectable suspension for macular edema associated with noninfectious uveitis: an in-depth look at efficacy and safety.

Patients with macular edema (ME) associated with uveitis (UME) are at risk for vision loss and decreased quality of life, and they often experience high health care costs and rates of workforce absenteeism. Systemically or locally delivered corticosteroids are the mainstay of treatment for UME. Although traditional corticosteroid treatments may demonstrate high levels of efficacy, systemic delivery carries the risk of potentially serious systemic adverse effects (AEs), and standard local modes of delivery may be associated with low bioavailability in posterior ocular tissues and steroid-associated AEs due to anterior ocular tissue exposure. Drug injection into the suprachoroidal space (SCS) allows for targeted delivery to chorioretinal tissues with high bioavailability in the posterior segment, as well as for inherent drug sequestration away from the anterior segment, which may lower the risk of AEs associated with anterior tissue exposure to steroids. A novel triamcinolone acetonide (TA) injectable suspension formulated for administration to the SCS, SCS-TA (Xipere®; Bausch + Lomb), received FDA approval in 2021 for the treatment of UME. It is administered via the SCS Microinjector® (Clearside Biomedical, Inc), a device specifically designed for SCS delivery of ocular therapeutics. This approval was based on results from the phase 3 PEACHTREE clinical trial (NCT02595398) that demonstrated the clinical efficacy-including significantly increased visual acuity and decreased central subfield thickness-and safety of SCS-TA in patients with UME. Results from this trial, as well as from its long-term observational extension (MAGNOLIA; NCT02952001) and an open-label safety study (AZALEA; NCT03097315), support the possibility that treatment with SCS-TA may address the burden of disease in patients with UME.

Diagnosis of Diabetic Retinopathy

Abstract: A diabetes-related eye condition called diabetic retinopathy (DR) can cause blindness or blurred vision. The risk of vision loss can be significantly reduced with early DR diagnosis and treatment. Due to the heterogeneity of retinal alterations between disease stages and the significant proportion of misdiagnosed and untreated DR cases, such diagnosis is a timeconsuming and challenging endeavour. A transfer learning method is used to speed up the process while several preprocessing algorithms are used to increase accuracy. The fundus image collection from the online Kaggle datasets was used in our experiment.

Comprehensive Management of Infantile Hemangiomas Involving the Periorbital Region.

Periocular infantile hemangioma (pIH) is associated with a risk of vision loss and requires urgent medical intervention. We evaluated the outcomes of the comprehensive management of 44 pIH patients (aged 2-6 months) with superficial (n = 11), deep (n = 15), and mixed (n = 18) subtypes, treated with a standard propranolol dose (2 mg kg -1 d -1 ) without any obvious side effects. Obvious and slight improvements were observed in 70.5% and 29.5% of patients, respectively. Obvious improvement was found in 96.3% of patients 3 months or younger but only 29.4% of patients older than 3 months ( P = 0.036) after 4 weeks of treatment. Thirteen patients demonstrated slight improvement and were treated with an increased propranolol dose (3 mg kg -1 d -1 ) in combination with corticosteroid injections or plastic surgery, which led to good outcomes. The patients were followed up for 12 to 18 months, with no cases of amblyopia or ametropia. Oral propranolol was effective in the treatment of pIH. Earlier propranolol use was associated with better outcomes. An increased propranolol dose combined with corticosteroid injections or plastic surgery is appropriate for patients with propranolol resistance.

Developing a "Fast-Track" Strategy for Interventional Management of Patients With Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) has an increasing incidence worldwide over the past decade, with a high economic burden on patients and society. Up to 10% of patients with IIH have progressive visual decline requiring an invasive intervention (including cerebrospinal fluid shunting, cerebral dural sinus stenting, or optic nerve sheath fenestration [ONSF]). IIH patients with visual decline usually undergo evaluation and initial management through the emergency department (ED) and commonly have a long hospital stay due to the lack of a dedicated methodology for evaluation and management, particularly in patients who present with visual loss (i.e., fulminant IIH). An innovative practice approach is needed to improve the means of multidisciplinary communication in care and evaluation of IIH patients. This paper aims to discuss the need for the development and implementation of a multidisciplinary "fast-track" strategy for the evaluation and management of patients with fulminant IIH or those with a suboptimal response to maximum tolerated medical treatment at risk for visual loss. We suggest that such a program could reduce hospital stay and ED visits and therefore reduce healthcare costs and improve patient outcomes by accelerating the management process.

A Case of Bilateral Pseudo Papilledema Revealing a Leber’s Hereditary Optic Neuropathy

Leber Hereditary Optic Neuropathy (LHON) is a mitochondrial disease caused by mutations in mitochondrial DNA affecting the respiratory complex I and leading to the death of retinal ganglion cells (RGCs) [1]. It is characterized by sudden onset and usually severe bilateral loss of central vision, predominantly in young men [2]. The risk of vision loss is 50% among men and 10% among women who carry LHON primary mutations in the mitochondrial DNA [3]. We report an atypic case of LHON in a young 11 years old girl.

P005 Performance of giant cell arteritis pre-test probability score in a tertiary care setting

Abstract Background/Aims Giant cell arteritis (GCA) is a chronic, idiopathic, granulomatous vasculitis of medium and large arteries comprising overlapping phenotypes of cranial arteritis and extracranial GCA. Vascular complications are generally due to delay in diagnosis and initiation of effective treatment. Due to the imminent risk of visual loss and other ischaemic complications it is vital to secure the diagnosis and it is equally important to exclude the mimics as the treatment of GCA has it's own complications. The objective of this quality improvement project was to assess the performance of Southend GCA Pre-test Probability Score (GCA PS) in a cohort of patients who were referred urgently with suspected GCA to the Rheumatology Department of Addenbrooke’s Hospital. Methods We analysed the data of 50 new patients seen between Aug 2019 and Feb 2020. GCA PS were calculated based on the information from GPs (clinical and biochemical data). The likely hood of GCA was determined on review after 1 month, based on the clinical, biochemical, histopathological data and response to steroids. Results A total of 50 cases were included in the study. Thirty-eight (76%) of them were females while 12(24%) were males. The median age was 68.5. The median probability score was 12, it ranged between 0 to 24. Finally, 25 patients were diagnosed as likely to have GCA based on clinical, biochemical, histopathological findings and response to steroids. The lowest probability score among those who had a positive biopsy was 10. The p value for the likelihood of GCA when the probability score was 10 or higher was 0.0001 which was very significant. Conclusion GCA pre-test probability score is a very promising and utilitarian tool for risk stratification of patients with suspected GCA and prediction of the likelihood of GCA. It enables exclusion of GCA in cases with low probability score and to have a higher degree of scrutiny in those with intermediate and high probability scores. Clinical diagnostic algorithm based on the BSR guidelines could further be utilised for confirmation. Disclosure P. Kadamban: None. S. Pattapola: None. H. Alkoky: None. N. Jordan: None. B. Gupta: None.

Transvenous Approaches to Embolization of Dural Arteriovenous Fistulae of the Cavernous Sinus.

Dural arteriovenous fistulae of the cavernous sinus (CS) (previously often referred to indirect carotid cavernous fistulas) are rare vascular shunts involving meningeal branches and osseous branches of the external or internal carotid arteries and the CS. They typically present with ocular symptoms including pain, conjunctival injection, and proptosis. Left untreated there may be a risk of vision loss, and fistulas with cortical venous reflux through either the deep or superficial venous system may cause intracranial venous congestion or hemorrhage. Endovascular embolization is the standard treatment, and while transarterial routes may appear possible, transarterial embolization has considerable risks of ischemic complications. Conversely, transvenous routes achieve a high rate of fistula occlusion with a low risk of peri-procedural morbidity. Procedural success depends on identification of the venous outflows from the fistula and localization of the fistulous point, to select the best route of access to the CS, including the inferior petrosal sinus (IPS), intercavernous sinus, or superior ophthalmic vein, among others. Even if the IPS is not visualized, it may be possible to recanalize it to gain access to the CS. Embolization can be performed with a combination of coils, fibered coils, and liquid embolic agents, focusing on occlusion of the fistulous point or blocking high-risk venous outflow pathways. In this review we will highlight procedural pearls and potential pitfalls and our typical approach to these lesions based on illustrative examples.

Texture Attention Network for Diabetic Retinopathy Classification

Diabetic Retinopathy (DR) is a disease caused by a high level of glucose in retina vessels. This malicious disease put millions of people around the world at risk for vision loss each year. Being a life-threatening disease, early diagnosis can be an effective step in the treatment and prevention of vision loss. To automate the early diagnosis process, computer-aided diagnosis methods are not only useful in detecting the diabetic signatures but also provide information regarding the diabetic grade for the optometrist to determine an appropriate treatment. Several deep classification models are proposed in the literature to solve the diabetic retinopathy classification task, however, these methods usually lack incorporate an attention mechanism to better encode the semantic dependency and highlight the most important region for boosting the model performance. To overcome these limitations, we propose to incorporate a style and content recalibration mechanism inside the deep neural network to adaptively scale the informative regions for diabetic retinopathy classification. In our proposed method, the input image passes through the encoder module to encode both high-level and semantic features. Next, by utilizing a content and style separation mechanism, we decompose the representational space into a style (e.g., texture features) and content (e.g., semantic and contextual features) representation. The texture attention module takes the style representation and applies a high-pass filter to highlight the texture information while the spatial normalization module uses a convolutional operation to determine the more informative region inside the retinopathy image to detect diabetic signs. Once the attention modules are applied to the representational features, the fusion module combines both features to form a normalized representation for the decoding path. The decoder module in our model performs both diabetic grading and healthy, non-healthy classification tasks. Our experiment on APTOS Kaggle dataset (accuracy 0.85) demonstrates a significant improvement compared to the literature work. This fact reveals the applicability of our method in a real-world scenario.

A case report on loss of vision secondary to odontogenic orbital cellulitis

We report a rare case of complete loss of vision secondary to odontogenic orbital cellulitis. A 54 years old female presented with 3 days history of left sided periorbital swelling and nasal discharge complaining of increasing facial pain. She was diagnosed with orbital cellulitis and treated empirically with intravenous antibiotic. Despite initial medical treatment, symptoms worsened leading to loss of vision. Indirect fundoscopy confirmed a left central retinal artery occlusion. An urgent CT revealed left maxillary sinus opacification with diffuse periorbital oedema, proptosis and no drainable orbital collection. She underwent Lynch Howarth procedure to reduce the orbital pressure. Ischaemic optic neuropathy and central retinal artery occlusion secondary to tension orbit odontogenic orbital cellulitis with no orbital collection are rare. We propose by serial intraocular measurements and maintaining the pressure below 21 mmHg with topical and systemic treatments, the risk of visual loss in patients presenting with similar pathology can be reduced.

Population-based Rate and Patterns of Diplopia in Giant Cell Arteritis

ABSTRACT Giant cell arteritis (GCA) is the most common vasculitis in older adults with permanent vision loss as a feared complication. Diplopia has been reported in a small percentage of patients with visual manifestations. The goal of this study was to determine the population-based rates and patterns of binocular diplopia from GCA. The Rochester Epidemiology Project (REP), a medical records linkage system was used to identify all residents of Olmsted County, Minnesota, USA, diagnosed with GCA between January 1, 1950 and December 31, 2019. Medical records were then reviewed to identify patients with binocular diplopia from GCA. There were 301 incident cases of GCA from 1950 to 2019. Fourteen (5%) patients presented with binocular diplopia. Of these 14 patients, nine (3%) had constant diplopia and five (2%) had transient diplopia. Among patients with constant diplopia, cranial nerve VI involvement was suspected in four (44%) cases. Systemic symptoms and inflammatory markers were similar in patients with and without diplopia. There was no difference in the rate of anterior ischaemic optic neuropathy between the two groups (7% vs. 7%, p = 1.00). In conclusion, this population-based study showed that binocular diplopia was present in 5% of patients with GCA, which could either be transient or constant. GCA patients with diplopia had similar systemic manifestations and risk of vision loss as GCA patients without diplopia.

Cuff-Method Thigh Arterial Occlusion Counteracts Cerebral Hypoperfusion Against the Push-Pull Effect in Humans.

Exposure to acute transition from negative (−Gz) to positive (+ Gz) gravity significantly impairs cerebral perfusion in pilots of high-performance aircraft during push—pull maneuver. This push—pull effect may raise the risk for loss of vision or consciousness. The aim of the present study was to explore effective countermeasures against cerebral hypoperfusion induced by the push—pull effect. Twenty healthy young volunteers (male, 21 ± 1 year old) were tested during the simulated push–pull maneuver by tilting. A thigh cuff (TC) pressure of 200 mmHg was applied before and during simulated push—pull maneuver (−0.87 to + 1.00 Gz). Beat-to-beat cerebral and systemic hemodynamics were measured continuously. During rapid −Gz to + Gz transition, mean cerebral blood flow velocity (CBFV) was decreased, but to a lesser extent, in the TC bout compared with the control bout (−3.1 ± 4.9 vs. −7.8 ± 4.4 cm/s, P < 0.001). Similarly, brain-level mean blood pressure showed smaller reduction in the TC bout than in the control bout (−46 ± 12 vs. −61 ± 13 mmHg, P < 0.001). The systolic CBFV was lower but diastolic CBFV was higher in the TC bout. The systemic blood pressure response was blunted in the TC bout, along with similar heart rate increase, smaller decrease, and earlier recovery of total peripheral resistance index than control during the gravitational transition. These data demonstrated that restricting thigh blood flow can effectively mitigate the transient cerebral hypoperfusion induced by rapid shift from −Gz to + Gz, characterized by remarkable improvement of cerebral diastolic flow.

Situational analysis of diabetic retinopathy screening in India: How has it changed in the last three years?

Of all the eye conditions in the contemporary Indian context, diabetic retinopathy (DR) attracts the maximum attention not just of the eye care fraternity but the entire medical fraternity. Countries are at different stages of evolution in structured DR screening services. In most low and middle income countries, screening is opportunistic, while in most of the high income countries structured population-based DR screening is the established norm. To reduce inequities in access, it is important that all persons with diabetes are provided equal access to DR screening and management services. Such programs have been proven to reverse the magnitude of vision-threatening diabetic retinopathy in countries like England and Scotland. DR screening should not be considered an endpoint in itself but the starting point in a continuum of services for effective management of DR services so that the risk of vision loss can be mitigated. Till recently all DR screening programs in India were opportunistic models where persons with diabetes visiting an eye care facility were screened. Since 2016, with support from International funders, demonstration models integrating DR screening services in the public health system were initiated. These pilots showed that a systematic integrated structured DR screening program is possible in India and need to be scaled up across the country. Many DR screening and referral initiatives have been adversely impacted by the COVID-19 pandemic and advocacy with the government is critical to facilitate continuous sustainable services.

Use of Geographic Information System Mapping in the Examination of Specialized Low Vision Resources and Areas of Need in Michigan

Introduction: The number of adults with visual impairments (i.e., blindness or low vision) is increasing, especially with the aging of the population. Although awareness of vision loss as a public health problem is growing, public health budgets are decreasing. This study exemplifies the use of publicly available secondary data and geographic information system (GIS) mapping to spatially map areas of potential higher risk for vision loss and identify where specialized, low vision resources are located, by county, in Michigan. Methods: County-level, publicly available data on risk factors for low vision (health and demographic) and specialized low vision resources (medical, rehabilitation, and community) are extracted from existing public health data sets and information published on the Internet. GIS mapping is applied to visually examine potential areas of disparity between need and resources. Results: Broadly speaking, counties in Michigan with the highest number of risk factors for low vision are clustered in the center of the Lower Peninsula and on the eastern and western ends of the Upper Peninsula. Areas that have fewer resources for low vision are clustered in the thumb area and the middle to upper part of the Lower Peninsula. Resources are concentrated near the state’s metropolitan areas (i.e., Detroit and suburbs, Kalamazoo, and Grand Rapids). Discussion: Maps can be helpful in locating areas of health disparities, but they need to be interpreted carefully such as by considering the county’s population size. Understanding the eligibility criteria of available services can help to uncover groups of persons not being served. Implications for practitioners: With increasing need for services and shrinking budgets, strategic planning may help alleviate anticipated shortfalls in available services. Use of publicly available data and GIS mapping may be an affordable and efficient method to identify areas of need and resources, for targeted public health efforts in vision.

Dexamethasone intravitreal implant for macular edema: a pilot study in a public health center

Introduction: Macula edema consists in one of the most common causes of visual impairment. Objective: To evaluate the safety and efficacy of continuous release of 0.7 mg dexamethasone (using implantable device) for treatment of macular edema. Methods: Cross-sectional observational study of 16 patients treated with 0.7 mg dexamethasone intraocular implant. Visual acuity, intraocular pressure and central macular thickness were recorded at baseline, 1-month and 3-month follow-up. Results: 15 eyes of 13 patients were included. Most eyes (n=9) improve visual acuity from baseline at 1-month follow-up; this improvement persisted through 3-monyh follow-up in six eyes. The central macular thickness decreased in the majority of the subjects at 1-month (n=12) and at 3-month (n=10) follow-up. Three eyes presented with elevated intraocular pressure. Conclusion: Dexamethasone implant can both reduce the risk of vision loss and improve anatomical features of macular edema due to several pathologies studied. This implant may be used safely and should be considered a therapeutic option to Brazilian Public Health System.