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Purpose: Patients with advanced keratoconus (KCN) are less likely to benefit from corneal cross-linking and may require a partial or full thickness keratoplasty. This study aimed to determine whether racial disparities exist in the clinical presentation and initial treatment recommendations for patients evaluated for KCN. Methods: A single-center retrospective review was conducted on all patients who presented to the cornea department for initial evaluation of KCN between 2018 and 2020. Patients who had undergone prior corneal procedures or surgeries were excluded. Baseline sociodemographic and clinical information was collected and stratified according to black versus non-black race. Generalized estimating equations were used to examine the association between black race and presenting corrected distance visual acuity (CDVA), presence of corneal scarring, keratometry values, Belin ABCD score, and treatment recommendations. Multivariate models were adjusted for patient demographics. Results: A total of 128 patients (251 eyes) were included in this study. In fully adjusted models, black individuals presented with significantly worse CDVA (p < 0.0001) and worse tomographic KCN staging according to the Belin ABCD criteria (p = 0.002) compared to non-blacks. Blacks were also more than four times as likely to present with a thinnest pachymetry < 400 μm (p < 0.0001) and more than three times as likely to have corneal scarring (p = 0.001). Blacks were more than seven times more likely to have keratoplasty recommended as treatment than conservative management such as corneal cross-linking or contact lenses (p = 0.004). Conclusion: Compared with their non-black counterparts, blacks presented with significantly more advanced KCN, which placed them at risk of requiring more invasive treatment plans. Future studies should investigate reasons for such late presentations and aim to mitigate disparities in the presentation and management of KCN. [ABSTRACT FROM AUTHOR]

Background: Early detection of ophthalmic conditions such as diabetic retinopathy (DR) and glaucoma is crucial to preventing vision loss. Previous studies have evaluated teleretinal screening programs for DR in well-insured populations. The purpose of this retrospective study was to evaluate a teleretinal screening program in a population of uninsured and underinsured patients seen in a Federally Qualified Health Center (FQHC). Methods: We conducted a retrospective chart review of patients (age ≥ 18) who underwent teleretinal imaging (TRI) at a FQHC between January 2015 and September 2019. TRI gradings and patient demographic and clinical information were abstracted. Factors associated with referral for a dilated eye exam by an ophthalmologist, adherence to recommended follow-up dilated eye exam, and ophthalmology visit attendance were examined. Results: 3130 TRIs were graded in 2216 eyes (1107 patients). 65.2% (N = 722) self-identified as Hispanic and 56.3% (N = 623) required interpreter services. Follow-up dilated fundus examination (DFE) was recommended for 388 TRIs, 49% (N = 190) of which were completed within 1 year. Adherence to the recommended ophthalmology exam was not associated with any baseline clinical or demographic characteristics (p > 0.05). Older age, male sex, hypertension, proteinuria, and higher A1c were significantly associated with greater odds of ophthalmology referral based on TRI (all p < 0.05), after adjusting for covariates. Less severe diabetic retinopathy, no insurance coverage, and Hispanic ethnicity were associated with lower odds of attending an ophthalmology visit, regardless of follow-up recommendations based on TRI (all p < 0.05). Conclusion: In an FQHC serving predominantly uninsured and underinsured patients, only 49% of recommended DFE were completed within one year. Less severe diabetic retinopathy, lack of insurance coverage, and Hispanic ethnicity were associated with a lower likelihood of having a DFE regardless of recommendation. These results suggest that greater system-level efforts are needed to increase adherence to follow-up eye exams after TRI to ensure sight-saving care for underserved populations. [ABSTRACT FROM AUTHOR]

Purpose: Although Alzheimer's disease (AD) is a leading cause of dementia worldwide, its clinical diagnosis remains a challenge. Optical coherence tomography (OCT) and OCT with angiography (OCTA) are non-invasive ophthalmic imaging tools with the potential to detect retinal structural and microvascular changes in patients with AD, which may serve as biomarkers for the disease. In this systematic review, we evaluate whether certain OCT and OCTA parameters are significantly associated with AD and mild cognitive impairment (MCI). Methods: PubMed database was searched using a combination of MeSH terms to identify studies for review. Studies were organized by participant diagnostic groups, type of imaging modality, and OCT/OCTA parameters of interest. Participant demographic data was also collected and baseline descriptive statistics were calculated for the included studies. Results: Seventy-one studies were included for review, representing a total of 6757 patients (2350 AD, 793 MCI, 2902 healthy controls (HC), and 841 others with a range of other neurodegenerative diagnoses). The mean baseline ages were 72.78± 3.69, 71.52± 2.88, 70.55± 3.85 years for AD, MCI and HC groups, respectively. The majority of studies noted significant structural and functional decline in AD patients when compared to HC. Although analysis of MCI groups yielded more mixed results, a similar pattern of decline was often noted amongst patients with MCI relative to HC. OCT and OCTA measurements were also shown to correlate with established measures of AD such as neuropsychological testing or neuroimaging. Conclusion: OCT and OCTA show great potential as non-invasive technologies for the diagnosis of AD. However, further research is needed to determine whether there are AD-specific patterns of structural or microvascular change in the retina and optic nerve that distinguish AD from other neurodegenerative diseases. Development of sensitive and specific OCT/OCTA parameters will be necessary before they can be used to detect AD in clinical settings. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the optical quality and tear film quality in patients with dry eye syndrome (DES) before and after using an intranasal neurostimulation device to stimulate tear production. Methods: Cross-sectional review of 33 eyes in 21 patients with DES who underwent optical quality and tear film analysis as part of their routine dry eye evaluation pre- and post-neurostimulation trial in office. Optical quality was assessed by measuring the objective scattering index (OSI) and modulation transfer function (MTF). The time to blink and mean tear film OSI were used to analyze the tear film. Results: Optical quality after the use of the intranasal neurostimulator improved with an average decrease (improvement) in OSI of 0.30± 0.68 (P=0.015) and an average increase (improvement) in MTF of 2.12± 9.2 (P=0.15). Pre-intranasal neurostimulation OSI had a positive correlation with age (Spearman's rho 0.60, p < 0.001), while MTF had a negative correlation (Spearman's rho − 0.38, p = 0.03). Pre-intranasal neurostimulation OSI had a negative correlation with MTF (Spearman's rho − 0.85, p < 0.001) and a positive correlation with tear film mean OSI (Spearman's rho 0.85, p < 0.001). Conclusion: The optical quality of patients with DES is improved with the use of intranasal neurostimulation for tear production, and there was a trend towards improved MTF though not statistically significant. Future studies are needed to follow patients longitudinally. [ABSTRACT FROM AUTHOR]

Purpose: To compare the agreement and efficiency of a swept source-optical coherence tomography biometer, IOLMaster 700 (IOLM700), and a low-coherence optical reflectometry biometer, LENSTAR LS 900 (LS900), when acquiring biometry measurements during cataract evaluation.Methods: A retrospective chart review of biometry measurements that were performed in 64 eyes of 32 patients on the same day using the LS900 and the IOLM700. The total image acquisition time per subject was compared between the two machines using a Wilcoxon rank-sum test. Bland–Altman plots showing the mean difference and 95% limits of agreement were graphed. Intraclass correlation coefficients (ICCs) were calculated for the mean axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and two keratometry mean values (K1 and K2) that were output from each device.Results: The average time to complete biometry measurements in both eyes was significantly shorter for the IOLM700 compared with the LS900 (44.5±12.4 vs 168.8±67.2 seconds, P<0.001). The Bland–Altman analysis and ICCs showed high degrees of agreement for the mean biometry values (ICC: AL 0.9999, ACD 0.9993, LT 0.9571, K1 0.9922, K2 0.9926) generated by the two devices.Conclusion: There was a high level of agreement between the mean biometry output measures for IOLM700 and LS900. However, it took ~73% less time on average to acquire the images when using the IOLM700 compared with the LS900. In a busy clinic setting, use of the IOLM700 for biometry measures may save time and prove more efficient. [ABSTRACT FROM AUTHOR]