Search

Zygomatic bone contributes to the orbital walls, and therefore associated injuries carry a high risk of severe dysfunction of the visual apparatus. The aim of our study was to retrospectively assess the spectrum and frequency of ophthalmic involvement in patients presenting with malar fracture, and the need for referral to an ophthalmologist for evaluation. In total, 102 patients presenting with malar fracture between January 2008 and August 2017 at Bapuji Dental College and Hospital, Davangere, Karnataka were enrolled in this study. Patients with confirmed malar fracture were categorized according to Henderson's classification, and associated ocular injuries were recorded. Assessment of the spectrum and frequency of ophthalmic involvement in patients presenting with different types of malar fracture was then carried out, followed by categorization of the need for referral to the ophthalmologist with regard to the associated ocular injury, as per the Al-Qurainy et al. (1991) scoring system, allocating the patients to early, routine, and non-referral categories. Statistically significant differences in proportions of various types of ophthalmic involvement were found between categories of malar fracture, and in degrees of ophthalmic involvement within each category of malar fracture, except in the Type II group of patients. The most severe ocular injuries were noted in Type VII followed by Type V, with the least severe injuries noted in Type II patients. According to the Al-Qurainy et al. (1991) scoring system, eight patients required early referral, 10 patients needed routine referral, and 84 patients were in the non-referral category. Categorization of referral of patients to an ophthalmologist in hospitals lacking ophthalmology departments can be based on the Al-Qurainy et al. classification of referral for Henderson's Type III, IV, and VI. Henderson's Type I and II patients need to be referred only in medicolegal cases. Henderson's Type VII and V patients require mandatory referral. [ABSTRACT FROM AUTHOR]

To analyze ophthalmology workforce supply and demand projections from 2020 to 2035. Observational cohort study using data from the National Center for Health Workforce Analysis (NCHWA). Data accessed from the Department of Health and Human Services, Health Resources and Services Administration (HRSA) website were compiled to analyze the workforce supply and demand projections for ophthalmologists from 2020 to 2035. Projected workforce adequacy over time. From 2020 to 2035, the total ophthalmology supply is projected to decrease by 2650 full-time equivalent (FTE) ophthalmologists (12% decline) and total demand is projected to increase by 5150 FTE ophthalmologists (24% increase), representing a supply and demand mismatch of 30% workforce inadequacy. The level of projected adequacy was markedly different based on rurality by year 2035 with 77% workforce adequacy versus 29% workforce adequacy in metro and nonmetro geographies, respectively. By year 2035, ophthalmology is projected to have the second worst rate of workforce adequacy (70%) of 38 medical and surgical specialties studied. The HRSA's Health Workforce Simulation Model forecasts a sizeable shortage of ophthalmology supply relative to demand by the year 2035, with substantial geographic disparities. Ophthalmology is one of the medical specialties with the lowest rate of projected workforce adequacy by 2035. Further dedicated workforce supply and demand research for ophthalmology and allied professionals is needed to validate these projections, which may have significant future implications for patients and providers. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

To quantify trends in ophthalmology practice consolidation in the United States. A retrospective cross-sectional study. Providers in the Centers for Medicare and Medicaid Services (CMS) National Downloadable File with a primary specialty designation of ophthalmology. We used the CMS database to determine national practice consolidation trends in ophthalmology on individual physician and group practice levels and analyzed by region, sex, and years spent in practice. We used the Cochran-Armitage test to determine the statistical significance of practice size differences between 2015 and 2022. Temporal practice size trends for physicians and practices in ophthalmology and regional, sex-specific, and age-related trends. Between 2015 and 2022, the number of ophthalmologists decreased from 17 656 to 17 615 (–0.2%), whereas the number of practices decreased from 7149 to 5890 (–18%). The percentage of ophthalmologists in practices of 1 to 2 members decreased from 35% to 28%, whereas those in groups of 50 or more increased from 7% to 11%. The percentage of practices with 1 to 2 members decreased from 75% to 71%, and those with 50 or more increased from 0.2% to 0.4%. Consolidation trends were significant on individual ophthalmologist (P < 0.001) and group practice (P < 0.001) levels. All regions, sexes, and subgroups of years spent in practice demonstrated consolidation (P < 0.001). The Northeast showed the greatest increase in groups of 50 or more physicians (+7%) between 2015 and 2022. Proportionally fewer female than male ophthalmologists were associated with practice sizes of 1 to 2 members in 2015 (29% and 36%, respectively) and 2022 (23% and 30%, respectively). Proportionally fewer ophthalmologists with 0 to 10 years of experience in practice were associated with practice sizes of 1 to 2 members than those with more than 30 years in practice in 2015 (18% and 48%, respectively) and 2022 (14% and 40%, respectively). Ophthalmology has undergone practice consolidation from 2015 to 2022. A decrease in the proportion of physicians affiliated with smaller practice sizes seems to have occurred. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Physician turnover is costly to health care systems and affects patient experience due to discontinuity of care. This study aimed to assess the frequency of turnover by ophthalmologists and identify physician and practice characteristics associated with turnover. Retrospective cross-sectional study. Actively practicing United States ophthalmologists included in the Centers for Medicare and Medicaid Services Physician Compare and Physician and Other Supplier Public Use File between 2014 and 2021. We collected data for each ophthalmologist that was associated with practice/institution and then calculated the rate of turnover both annually in each year window and cumulatively as the total proportion from 2014 to 2021. Multivariable logistic regression analysis was used to identify physician and practice characteristics associated with turnover. We also evaluated turnover characteristics surrounding the Coronavirus disease 2019 (COVID-19) pandemic. Ophthalmologist turnover, defined as a change of an ophthalmologist's National Provider Identifier practice affiliation from one year to the next. Of 13 264 ophthalmologists affiliated with 3306 unique practices, 34.1% separated from at least 1 practice between 2014 and 2021. Annual turnover ranged from 3.7% (2017) to 19.4% (2018), with an average rate of 9.4%. Factors associated with increased turnover included solo practice (adjusted odds ratio [aOR], 9.59), university affiliation (aOR, 1.55), practice location in the Northeast (aOR, 1.39), and practice size of 2 to 4 members (aOR, 1.21; P < 0.05 for all). Factors associated with decreased turnover included male gender (aOR, 0.87) and more than 5 years of practice: 6 to 10 years (aOR, 0.63), 11 to 19 years (aOR, 0.54), 20 to 29 years (aOR, 0.36), and ≥ 30 years (aOR, 0.18; P < 0.05 for all). In the initial year (2020) of the COVID-19 pandemic, annual turnover increased from 7.8% to 11.0%, then decreased to 8.7% in the postvaccine period (2021). One-third of United States ophthalmologists separated from at least 1 practice from 2014 through 2021. Turnover patterns differed by various physician and practice characteristics, which may be used to develop future strategies for workforce stability. Because administrative data cannot solely determine reasons for turnover, further investigation is warranted given the potential clinical and financial implications. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Epidemiological data on the use of eye-related emergency services by children are limited. The objective of this study was to determine how COVID-19 affected the epidemiological trends of pediatric ocular emergencies. We performed a retrospective chart review of children under the age of 18 years who visited our eye-related emergency department between March 17 and June 7, 2020 and between March 18 and June 9, 2019. This was a descriptive and comparative analysis of the two study periods based on the demographic characteristics of patients and the diagnosis reported by the ophthalmologist in the digital medical charts. One of the investigators performed a second reading of the files to homogenize the diagnosis classification based on the most frequently found items. In total, 754 children were seen in our eye-related emergency department during the 2020 study period versus 1399 in 2019, representing a 46% decrease. In 2019, the four main diagnoses were traumatic injury (30%), allergic conjunctivitis (15%), infectious conjunctivitis (12%), and chalazion/blepharitis (12%). In the 2020 study period there was a significant decrease in the proportion of patients presenting with traumatic injuries (p < 0.001), infectious conjunctivitis (p = 0.03), and chalazion/blepharitis (p < 0.001). Consultations for chalazion/blepharitis were the most affected by the pandemic, followed by traumatic injuries (−72% and −64%, respectively). The proportion of patients who required surgery after trauma was higher in 2020 than in 2019 (p < 0.01), but the absolute number of severe trauma cases remained stable. The COVID-19 pandemic was accompanied by a decrease in the overall use of a pediatric eye-related emergency services in Paris. Visits due to benign causes and ocular trauma also decreased, but visits for more severe pathologies were not affected. Longer-term epidemiological studies may confirm or refute a change in eye emergency department use habits. [ABSTRACT FROM AUTHOR]

The eye is a unique structural and functional anatomic unit of the face and requires specific care and attention. Often, dermatologists are not familiar with the routine needs of the eyelid area. Despite evidence showing that lid hygiene may serve as an important supplement to therapeutic management of eyelid disorders, lid hygiene is often overlooked. Ophthalmologists and dermatologists have an important role to play in educating patients on the importance of proper eyelid hygiene and ensuring patient compliance. We review eyelid anatomy and function to better understand how these structures relate to potential disease processes. We also review current recommendations for routine eyelid care and discuss the need for further advancements in promoting eyelid health. [ABSTRACT FROM AUTHOR]

Understanding approaches to sustainability in cataract surgery and their risks and benefits. In the United States, health care is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissions, which lead to a steadily increasing list of health concerns ranging from trauma to food instability. We conducted a literature review to identify the benefits and risks of sustainability interventions. We then organized these interventions into a decision tree for use by individual surgeons. Identified sustainability interventions fall into the domains of advocacy and education, pharmaceuticals, process, and supplies and waste. Existing literature shows certain interventions may be safe, cost-effective, and environmentally friendly. These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate. The literature was lacking on the benefits or risks for some interventions, such as switching specific single-use supplies to reusables or implementing a hub-and-spoke–style operating room setup. Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks. Ophthalmologists can engage in a variety of safe and effective approaches to reduce or eliminate dangerous GHG emissions associated with cataract surgery. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

Retinopathy of prematurity (ROP) care in Brazil varies in availability of resources and infrastructure. A cross-sectional survey was conducted among ophthalmologists of the Brazilian ROP Group (BRA-ROP) to assess the profiles and practices of ophthalmologists involved in ROP care. A total of 78 responses of BRA-ROP participants (79%) were included. Participants were mostly retina experts (64.1%), female (65.4%), and over 40 years of age (60.2%). Eighty-six percent reported following Brazil's ROP screening criteria. Retinal imaging is available to 16.9% of respondents; fluorescein angiography, to 1.4%. For ROP stage 3 zone II (with plus disease), laser treatment was the preferred treatment (78.9%); for aggressive ROP, anti-VEGF was favored (66.2%). There were significant regional differences in treatment choice. Not all respondents continued to follow treated patients after discharge from the neonatal intensive care unit, highlighting an aspect of ROP care in need of improvement. [ABSTRACT FROM AUTHOR]

Ocular surface disease is most common and prevalent eye disorder that is difficult to precisely diagnose due to its complexity more than ophthalmologists realize. Biomicroscopic diagnosis of this disease at the hospital is large economic and humanistic burden such as cost and visit duration. This work presents the first study on automatic recognition of ocular surface disease by smartphone imaging and bilateral densely connected convolutional networks. Our new solution is to use cheap smartphones as a replacement of expensive biomicroscopes to image the ocular surface. To recognize ocular surface disease on images, we propose new bilateral densely connected convolutional networks that introduce an additional cheap hybrid operator to extract more diverse features and concatenate double outputs of each layer into the feature maps as inputs of the next layer, leading to a significant increase of efficient feature reuse of dense connections while critically reducing the amount of parameters. Three ophthalmologists used different smartphones to collect a large amount of ophthalmic images with various ocular surface diseases to evaluate our method, with the validation results showing that our method provides a promising and effective strategy to accurately diagnose ocular surface disorders. In particular, our smartphone image deep learning based automatic recognition method attains much higher average recognition accuracy of 91.3% than 87.1% of densely connected networks, while it only needs 0.25M model parameters. Additionally, our method can be conveniently integrated into smartphones for subjects to monitor eye surface disorders without going to hospital. The pre-trained Bi-DenseNet model with its code will be available at GitHub soon. • First use smartphone photographs for automatic OSD detection and recognition. • Explore new bilateral densely convolutional networks for image classification. • Introduce smartphone imaging to replace biomicroscopic imaging for OSD screening. • A new clinical solution to diagnose and monitor OSD outside the hospital. • Provide ophthalmologists with an effective way to reduce their labor and mental burden. [ABSTRACT FROM AUTHOR]

This study highlights the disparity between the prevalence of adult strabismus in the United States and the limited number of surgeons performing adult strabismus surgery on Medicare beneficiaries. Only 12.2% of pediatric ophthalmologists billed Medicare for adult strabismus procedures during the study period. Additionally, geographic disparities of surgeons performing adult strabismus surgery were evident, with drastically different surgeon-to-patient ratios by state. Overall, the study raises concerns about the adequacy of the surgeon supply to meet the demand for adult strabismus cases. [ABSTRACT FROM AUTHOR]

To evaluate differences in Medicare reimbursements between male and female ophthalmologists between 2013 and 2019. Retrospective cohort study. Ophthalmologists receiving Medicare reimbursements between 2013 and 2019. The Centers for Medicare and Medicaid Services Physician and Other Supplier Public Use File was used to determine total reimbursements and number of services submitted by ophthalmologists between 2013 and 2019. Reimbursements were standardized to account for geographic differences in Medicare reimbursement per service. Data from the American Community Survey (ACS) were used to determine socioeconomic characteristics (unemployment, poverty, income, and education) by zip code for the location of each physician's practice. A multivariate linear regression model was used to evaluate differences in annual reimbursements by sex, accounting for calendar year, years of experience, total number of services, ACS zip code data, and proportion of procedural services. Annual Medicare reimbursement and use of billing codes (e.g., outpatient office visits and eye examinations, diagnostic testing, laser treatment, and surgery). Among 20 281 ophthalmologists who received Medicare reimbursements between 2013 and 2019, 15 451 (76%) were men. The most common billing codes submitted were for outpatient visits and eye examinations (13.8 million charges/year), diagnostic imaging of the retina (5.6 million charges/year), intravitreal injections (2.9 million charges/year), and removal of cataract with insertion of lens (2.4 million charges/year). Compared with men, female ophthalmologists received less in median annual reimbursements (median, $94 734.21 [interquartile range (IQR), $30 944.52–$195 701.70] for women vs. $194 176.90 [IQR, $76 380.76–$355 790.80] for men; P < 0.001) and billed for fewer annual median services (median, 1228 [IQR, 454–2433] vs. 2259 [IQR, 996–4075, respectively]; P < 0.001). After adjustment for covariates, female ophthalmologists billed for 1015 fewer services (95% confidence interval [CI], 1001–1029; P < 0.001) and received $20 209.12 less in reimbursements than men (95% CI, –$21 717.57 to –$18 700.66; P < 0.001). Female ophthalmologists billed for fewer services and received less in reimbursement from Medicare than men over time and across all categories of billing codes. Disparities persisted after controlling for physician and practice characteristics. [ABSTRACT FROM AUTHOR]

Degenerative retinoschisis is a common condition characterized by elevation of the inner layers of the peripheral retina. While uncomplicated retinoschisis (i.e., with no associated retinal layer breaks) is almost invariably a benign process, retinal detachment associated with isolated outer layer breaks (termed schisis-detachment) is fairly common. Historically, schisis-detachment has been treated with a variety of interventions, ranging from retinopexy to intraocular surgery. Based on published descriptions of the natural history of the disease, these interventions are likely unnecessary in many cases and may place the patient's vision at unnecessary risk. Progressive symptomatic schisis-related retinal detachment, on the other hand, is a vision threatening condition that requires intervention. While clinical examination remains the mainstay of diagnosis, recent advances in multimodal imaging can provide supplemental information in subtle cases and may prove valuable for long-term disease monitoring. When evaluating patients with peripheral retinal elevation, it is important for ophthalmologists to make an accurate diagnosis and to understand the risk-benefit ratio associated with intervention. Thus, we summarize the current literature on the natural history, clinical and imaging diagnosis, and surgical management of degenerative retinoschisis and its related complications. [ABSTRACT FROM AUTHOR]

There is a nationwide shortage of pediatric ophthalmologists, with trends in fellowship applicants foreshadowing a continued reduction in the number of active pediatric ophthalmologists in the years ahead. In this study, we investigated whether similar fellowship applicant shortages exist in other pediatric surgical subspecialties. We compared the match statistics of six pediatric surgical fellowships from 2015 to 2020. During the 6-year interval, a median of 12.2 pediatric ophthalmology fellowship positions (IQR, 12.1-12.4) were offered per 100 graduating residents, 8.7% of ophthalmology residents (IQR, 8.3%-9.3%) pursued pediatric subspecialty training, and 72% of available pediatric fellowship positions (IQR, 69%-74%) were filled. Pediatric general surgery had the highest percentage of available fellowship positions filled, 99% (IQR, 98%-100%), which was significantly higher than for pediatric ophthalmology (P = 0.024). None of the other subspecialties had a significant difference in available positions filled compared to pediatric ophthalmology (P > 0.05).▪ [ABSTRACT FROM AUTHOR]

To develop deep learning models to perform automated diagnosis and quantitative classification of age-related cataract from anterior segment photographs. DeepLensNet was trained by applying deep learning models to the Age-Related Eye Disease Study (AREDS) dataset. A total of 18 999 photographs (6333 triplets) from longitudinal follow-up of 1137 eyes (576 AREDS participants). Deep learning models were trained to detect and quantify nuclear sclerosis (NS; scale 0.9–7.1) from 45-degree slit-lamp photographs and cortical lens opacity (CLO; scale 0%–100%) and posterior subcapsular cataract (PSC; scale 0%–100%) from retroillumination photographs. DeepLensNet performance was compared with that of 14 ophthalmologists and 24 medical students. Mean squared error (MSE). On the full test set, mean MSE for DeepLensNet was 0.23 (standard deviation [SD], 0.01) for NS, 13.1 (SD, 1.6) for CLO, and 16.6 (SD, 2.4) for PSC. On a subset of the test set (substantially enriched for positive cases of CLO and PSC), for NS, mean MSE for DeepLensNet was 0.23 (SD, 0.02), compared with 0.98 (SD, 0.24; P = 0.000001) for the ophthalmologists and 1.24 (SD, 0.34; P = 0.000005) for the medical students. For CLO, mean MSE was 53.5 (SD, 14.8), compared with 134.9 (SD, 89.9; P = 0.003) for the ophthalmologists and 433.6 (SD, 962.1; P = 0.0007) for the medical students. For PSC, mean MSE was 171.9 (SD, 38.9), compared with 176.8 (SD, 98.0; P = 0.67) for the ophthalmologists and 398.2 (SD, 645.4; P = 0.18) for the medical students. In external validation on the Singapore Malay Eye Study (sampled to reflect the cataract severity distribution in AREDS), the MSE for DeepSeeNet was 1.27 for NS and 25.5 for PSC. DeepLensNet performed automated and quantitative classification of cataract severity for all 3 types of age-related cataract. For the 2 most common types (NS and CLO), the accuracy was significantly superior to that of ophthalmologists; for the least common type (PSC), it was similar. DeepLensNet may have wide potential applications in both clinical and research domains. In the future, such approaches may increase the accessibility of cataract assessment globally. The code and models are available at https://github.com/ncbi/deeplensnet. [ABSTRACT FROM AUTHOR]

To identify the role of gender and other factors in influencing ophthalmologists' compensation. Cross-sectional study. U.S. practicing ophthalmologists. Between January and March 2020, an anonymous survey was sent to U.S. residency program directors and practicing ophthalmologists who recently completed residency training. Respondents who completed residency ≤ 10 years ago and responded to questions about gender, fellowship training, state of practice, and salary were included. Propensity score match (PSM) analysis was performed with age, academic residency, top residency, fellowship, state median wage, practice type, ethnicity, and number of workdays. Multivariate linear regression (MLR) analysis controlled for additional factors along with the aforementioned variables. Base starting salary with bonus (SWB) received in the first year of clinical position was the main outcome measure. A multiplier of 1.2 (20%) was added to the base salary to account for bonus. Of 684 respondents, 384 (56% were female, 44% were male) from 68 programs were included. Female ophthalmologists received a mean initial SWB that was $33 139.80 less than that of their male colleagues (12.5%, P = 0.00). The PSM analysis showed an SWB difference of −$27 273.89 (10.3% gap, P = 0.0015). Additionally, SWB differences were calculated with the number of workdays substituted by operating room (OR) days (−$27 793.67 [10.5% gap, P = 0.0013]) and clinic days (−$23 597.57 [8.90% gap, P = 0.0064]) in separate PSM analyses. The SWB differences between genders were significant using MLR analyses, which also controlled for work, clinic, and OR days separately (−$22 261.49, $−18 604.65, and $−16 191.26, respectively; P = 0.017, P = 0.015, P = 0.002, respectively). Gender independently predicted income in all 3 analyses (P < 0.05). Although an association between gender and the attempt to negotiate was not detected, a greater portion of men subjectively reported success in negotiation (P = 0.03). Female ophthalmologists earn significantly less than their male colleagues in the first year of clinical practice. Salary differences persist after controlling for demographic, educational, and practice type variables with MLR and PSM analyses. These income differences may lead to a substantial loss of accumulated earnings over an individual's career. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) chatbots are able to explain complex concepts using plain language. The aim of this study was to assess the accuracy of three AI chatbots answering common questions related to contact lens (CL) wear. Three open access AI chatbots were compared: Perplexity, Open Assistant and ChatGPT 3.5. Ten general CL questions were asked to all AI chatbots on the same day in two different countries, with the questions asked in Spanish from Spain and in English from the U.K. Two independent optometrists with experience working in each country assessed the accuracy of the answers provided. Also, the AI chatbots' responses were assessed if their outputs showed any bias towards (or against) any eye care professional (ECP). The answers obtained by the same AI chatbots were different in Spain and the U.K. Also, statistically significant differences were found between the AI chatbots for accuracy. In the U.K., ChatGPT 3.5 was the most and Open Assistant least accurate (p < 0.01). In Spain, Perplexity and ChatGPT were statistically more accurate than Open Assistant (p < 0.01). All the AI chatbots presented bias, except ChatGPT 3.5 in Spain. AI chatbots do not always consider local CL legislation, and their accuracy seems to be dependent on the language used to interact with them. Hence, at this time, although some AI chatbots might be a good source of information for general CL related questions, they cannot replace an ECP. [ABSTRACT FROM AUTHOR]

To determine whether the geographic density of pediatric ophthalmologists is associated with the rate of children treated for strabismus and amblyopia. This cross-sectional study included children treated for strabismus and amblyopia 0-17 years of age with commercial insurance who were included in the Vision and Eye Health Surveillance System. Additionally, pediatric ophthalmologists by state were determined using the American Association for Pediatric Ophthalmology and Strabismus website. Unadjusted linear regression was used to compare the geographic density of pediatric ophthalmologists and the rate of children treated for strabismus and amblyopia by state in 2016. This was repeated using multivariable linear regression, controlling for race, poverty, non-English-speaking children, and insurance coverage for children by state. New York and Mississippi had the highest and lowest rates of treatment of strabismus and amblyopia, with 3.97 and 0.83 children treated per 100 children, respectively. The geographic density of pediatric ophthalmologists was associated with the rate of children treated for strabismus and amblyopia in unadjusted analyses (β = 0.62, P < 0.001). Further, the geographic density of pediatric ophthalmologists was associated with the rate of children treated for strabismus and amblyopia in adjusted analyses (β = 0.61, P < 0.001). The geographic density of pediatric ophthalmologists by state was positively associated with the rate of children treated for strabismus and amblyopia. [ABSTRACT FROM AUTHOR]

Surgical treatment of spontaneous cerebrospinal fluid (CSF) leak is now performed by ENT surgeons, endonasal endoscopy being preferred to craniotomy as less invasive. However, it is often the symptom of underlying idiopathic intracranial hypertension, which lies outside the traditional sphere of ENT competence. Surgery is a necessary step, but should not obscure the need to treat the underlying pathology. This treatment is complex, and requires multidisciplinary team-work between otorhinolaryngologist, ophthalmologist, neurologist, neurosurgeon, radiologist, dietician, endocrinologist and psychotherapist. The present update details this multidisciplinary management to which the ENT surgeons must be attentive before and after spontaneous CSF leak repair. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Optometry is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To evaluate in a sample of normal and keratoconic eyes a simple Bayesian network classifier for keratoconus identification that uses previously developed topographic indices, calculated directly from the digital analysis of the Placido ring images.Methods: A comparative study was performed on a total of 60 eyes from 60 patients (age 20-60 years) from the Department of keratoconus of INVISION Ophthalmology clinic (Almería, Spain). Patients were divided into two groups depending on their preliminary diagnosis based on the classical topographic criteria: a control group without topographic alteration (30 eyes) and a keratoconus group (30 eyes). The keratoconus group included all grades except grade IV with excessively distorted corneal topography. All cases were examined using the CSO topography system (CSO, Firenze, Italy), and primary corneal Placido-indices were computed, as described in literature. Finally, a classifier was built by fitting a conditional linear Gaussian Bayesian network to the data, using the 5- and 10-fold cross-validation. For comparison, the original data were perturbed with random white noise of different magnitude.Results: The naïve Bayes classifier showed perfect discrimination ability among normal and keratoconic corneas, with 100% of sensibility and specificity, even in the presence of a very significant noise.Conclusions: The Bayesian network classifiers are highly accurate and proved a stable screening method to assist ophthalmologists with the detection of keratoconus, even in the presence of noise or incomplete data. This algorithm is easily implemented for any Placido topographic system. [ABSTRACT FROM AUTHOR]

In recent months, the COVID-19 pandemic has threatened the financial viability of pediatric ophthalmology practices. To measure the economic impact, the American Association of Pediatric Ophthalmology and Strabismus (AAPOS) Socio-economic Committee surveyed current US members at the peak of the COVID shutdown, in April 2020. With a robust response rate, the survey portrays that some pediatric ophthalmology practices are ominously strained, if not irreparably harmed. [ABSTRACT FROM AUTHOR]

• Derivation of an alternative method for the interpretation of deep learning models. • Design a human-expert level deep learning diabetic retinopathy classification model. • Design a diabetic retinopathy interpretable classifier. • Visualization of typical feature and input space score map samples. In this paper we present a diabetic retinopathy deep learning interpretable classifier. On one hand, it classifies retina images into different levels of severity with good performance. On the other hand, this classifier is able of explaining the classification results by assigning a score for each point in the hidden and input spaces. These scores indicate the pixel contribution to the final classification. To obtain these scores, we propose a new pixel-wise score propagation model that for every neuron, divides the observed output score into two components. With this method, the generated visual maps can be easily interpreted by an ophthalmologist in order to find the underlying statistical regularities that help to the diagnosis of this eye disease. [ABSTRACT FROM AUTHOR]

Lam Qua, a Chinese artist who painted in the Western style, was hired by American ophthalmologist and missionary Peter Parker to paint Parker's Chinese patients. Most of Lam Qua's paintings depict patients with rather large tumors located in various areas across the body; there are a few that are also of dermatologic interest. This contribution explores Lam Qua's paintings that depict a cutaneous horn, gangrenous necrosis, and an ulcerating tumor. [ABSTRACT FROM AUTHOR]

Segmentation of lesions from fundus images is an essential prerequisite for accurate severity assessment of diabetic retinopathy. Due to variation in morphologies, number and size of lesions, the manual grading process becomes extremely challenging and time-consuming. This necessitates the need of an automatic segmentation system that can precisely define the region of interest boundaries and assist ophthalmologists in speedy diagnosis along with diabetic retinopathy severity grading. The paper presents a modified U-Net architecture based on residual network and employs periodic shuffling with sub-pixel convolution initialized to convolution nearest neighbour resize. The proposed architecture has been trained and validated for microaneurysm and hard exudate segmentation on two publicly available datasets namely IDRiD and e-ophtha. For IDRiD dataset, the network obtains 99.88% accuracy, 99.85% sensitivity, 99.95% specificity and dice score of 0.9998 for both microaneurysm and exudate segmentation. Further, when trained on e-ophtha and validated on IDRiD dataset, the network shows 99.98% accuracy, 99.88% sensitivity, 99.89% specificity and dice score of 0.9998 for microaneurysm segmentation. For exudates segmentation, the model obtained 99.98% accuracy, 99.88% sensitivity, 99.89% specificity and dice score of 0.9999, when trained on e-ophtha and validated on IDRiD dataset. In comparison to existing literature, the proposed model provides state-of-the-art results for retinal lesion segmentation. [ABSTRACT FROM AUTHOR]

The internet is a major source of health information for patients and parents. The information found online influences patients' and caregivers' understanding of diagnoses and decision making regarding management. We report the results of a survey completed by 4 fellowship-trained pediatric ophthalmologists evaluating the accuracy and clarity of various websites that provide information on amblyopia and strabismus. [ABSTRACT FROM AUTHOR]

Corneal and scleral disorders related to inflammatory rheumatic diseases vary both in frequency and in severity. Sicca syndrome and its complications are the most common ocular manifestations and, together with episcleritis, can usually be managed by topical treatments. In contrast, the various forms of scleritis and peripheral ulcerative keratitis generally require systemic glucocorticoid therapy and the initiation or intensification of immunosuppressive treatment. Corneal and scleral manifestations are inaugural in a few patients with chronic inflammatory rheumatic disease. No direct information is available on the frequency of severe corneal and scleral involvement, which can only be estimated by extrapolating data from case-series or cohorts, many of which are historical. Similarly, given the absence of randomized controlled trials, treatment decisions must rely on clinical experience acquired in referral centers and on reports of small case-series studies. The rheumatologist and ophthalmologist must work closely together to ensure the prompt and optimal management of these potentially serious conditions. [ABSTRACT FROM AUTHOR]

A 20-year-old woman presented with bilateral constant positive visual phenomenon since she was 9 years old. The symptoms had been worsening and becoming more intrusive in the last 3 years. Recently she has also had a migrainous episode. All ophthalmic and neurological investigations were normal. Her symptoms met the diagnostic criteria for visual snow. The diagnosis was explained, and the patient was reassured. Ophthalmologists and neurologists need to be aware of this condition to avoid over investigation and worsening of patient anxiety. [ABSTRACT FROM AUTHOR]

To investigate ophthalmologists' rate of attestation to meaningful use (MU) of their electronic health record (EHR) systems in the Medicare EHR Incentive Program and their continuity and success in receiving payments in comparison with other specialties. Administrative database study. Eligible professionals participating in the Medicare EHR Incentive Program. Based on publicly available data sources, subsets of payment and attestation data were created for ophthalmologists and for other specialties. The number of eligible professionals attesting was determined using the attestation data for each year and stage of the program. The proportion of attestations by EHR vendor was calculated using all attestations for each vendor. Numbers of ophthalmologists attesting by year and stage of the Medicare EHR Incentive Program, incentive payments, and number of attestations by EHR vendor. In the peak year of participation, 51.6% of ophthalmologists successfully attested to MU, compared with 37.1% of optometrists, 50.2% of dermatologists, 54.5% of otolaryngologists, and 64.4% of urologists. Across the 6 years of the program, ophthalmologists received an average of $17 942 in incentive payments compared with $11 105 for optometrists, $16 617 for dermatologists, $20 203 for otolaryngologists, and $23 821 for urologists. Epic and Nextgen were the most frequently used EHRs for attestation by ophthalmologists. Ophthalmology as a specialty performed better than optometry and dermatology, but worse than otolaryngology and urology, in terms of the proportion of eligible professionals attesting to MU of EHRs. Ophthalmologists were more likely to remain in the program after their initial year of attestation compared with all eligible providers. The top 4 EHR vendors accounted for 50% of attestations by ophthalmologists. [ABSTRACT FROM AUTHOR]

To test a model of integrated pediatric eye care delivery and examine the prevalence and factors associated with childhood ocular morbidity in a peri-urban setting in Bangladesh. Cross-sectional, population-based study. The study was conducted in three phases among children aged ≤15 years. Trained community health workers (CHWs) conducted awareness intervention and identified children with ocular problems. These children were then referred to the base hospital for examination and treatment by ophthalmologists. A pediatric ophthalmologist further examined the children with complicated eye diseases and ensured treatment at a tertiary public eye hospital. Awareness, referral patterns, and health-seeking behavior were also examined. All data were analyzed statistically using Statistical Package for Social Sciences. CHWs screened 33,549 eligible children and identified 1887 cases with ocular morbidity. The prevalence of ocular morbidity and childhood blindness were 5.63% (95% confidence interval [CI] = 5.27–6.16) and 0.060% (95% CI = 0.03–0.11), respectively. The most commonly observed ocular morbidities were refractive error (3.24%; 95% CI = 3.11–3.45), allergic eye conditions (1.2%; 95% = CI 0.74–1.27), and nasolacrimal duct obstruction (0.52%; 95% CI = 0.25–0.74). Blindness was more frequently seen in children aged <5 years than in those aged 5–15 years (χ2 = 7.25; P = 0.007). The causes of blindness were corneal opacity, congenital eye anomaly, cataract, retinopathy of prematurity, and retinoblastoma. The prevalence of ocular morbidity was higher among older children, boys, children with low parental education and income, and children from households dwelling in slums. This study demonstrated that in a setting where screening and treatment for vision problems remain low, ocular morbidity among children could be easily identified through well-designed community-based screening programs involving appropriately trained CHWs. Community mobilization, awareness, and early detection of childhood eye diseases, with effective referral mechanisms for accessing appropriate care, are crucially important to improve service delivery. • Trained community health workers conducted awareness interventions, identified and referred children with ocular problems. • Refractive error was the most common ocular morbidity. • Ocular morbidity was associated with older children and slum dwellers. • Gender inequalities existed in care seeking; fewer girls sought care from the referral hospital. • Community mobilization, early detection and effective referral are important for improving eye care service delivery. [ABSTRACT FROM AUTHOR]

Perceptions of the quality of life (QOL) associated with vision loss vary widely. Herein, we consider the perceptions of patients with vision loss as the criterion for QOL quantification associated with vision loss. With the QOL instrument, time tradeoff utility analysis, the upper anchor of 1.00 is associated with permanent normal vision, whereas the lower anchor of 0.00 is associated with death. A time tradeoff utility of 0.26 is associated with no light perception bilaterally. Patients with legal blindness in the US (≤20/200 vision bilaterally) have a mean time tradeoff utility of 0.47. The general public, however, associates legal blindness with a time tradeoff utility of 0.86. Thus, legally blind patients consider their QOL loss from blindness to be 279% (1.00-0.47/1.00-0.86) worse than does the American public. Public estimates of the QOL loss from blindness (utility = 0.86) suggest it is less debilitating than patient QOL estimates for migraine headaches (utility = 0.83). The mean medical student blindness utility estimate is 0.86, whereas that for non-ophthalmic physicians is 0.82. Ophthalmologists underestimated the QOL associated with vision loss in macular degeneration patients by 96%-750%. Underestimating the QOL loss from blindness likely diminishes the perceived benefit of blindness interventions. Minimization of interventional benefit by underestimating patient impairment from vision loss could lead to adverse consequences for patients with vision loss, for vision research, for and those who treat vision loss. [ABSTRACT FROM AUTHOR]

Children with unexplained bilateral cataracts routinely undergo testing for genetic, infectious, and metabolic etiologies. We evaluated the diagnostic yield of various tests ordered by pediatric ophthalmologists to evaluate bilateral cataracts in children at a single institution. We retrospectively identified all children with bilateral unexplained cataracts who underwent cataract surgery by a pediatric ophthalmologist at Children's Hospital Colorado from 2006 to 2022. We reviewed the results of genetic, infectious, and metabolic testing ordered by pediatric ophthalmologists to evaluate the cataracts in these children. A total of 43 children met inclusion criteria. Of these, 34 (79%) had genetic testing, 34 (79%) had infectious disease testing, 33 (77%) had galactosemia testing, and 17 (40%) had urine-reducing substances testing performed during their cataract evaluation. Of the genetic tests ordered, 17 (50%) revealed a pathogenic mutation associated with cataracts. Twenty-three (68%) patients were IgG-positive for a TORCH infection, but no child was found to be positive on confirmatory testing. Of the galactosemia and URS tests ordered, 3 tests (9%) and 1 (6%) test were initially found to be abnormal, respectively, but confirmatory testing and clinical judgment ruled out metabolic disease in each case. Genetic testing should be strongly considered in all cases of unexplained bilateral pediatric cataracts. Metabolic and infectious testing is best considered only after consultation with the child's pediatrician, guided by the patient's clinical context and the availability of genetic testing. [ABSTRACT FROM AUTHOR]

• In this paper, luminosity and contrast enhancement scheme is proposed for retinal image. • Proposed method is tested on publicly available three (STARE, CHASEDB, and DRIVE) image datasets. • The suggested method performs the illumination improvement, details correction, and denoising. • A maximum a posterior (MAP) estimator is used to calculate the illumination and reflection. • Performance is illustrated against the state-of-the-art methods using a well-known numerical metric. Fundus imaging is used to diagnose many common diseases in human vision. Because of uneven brightness, blur effect, and low contrast, fundus images are not helpful for diagnosis. The proposed technique provides an effective enhancement technique for fundus images. The method performs the appropriate illumination improvement, details correction, and denoising operations. A maximum a posterior (MAP) estimator is used to calculate the illumination and reflection components, which is motivated by the retinex method. The estimated illumination part is put through gamma correction to smooth its unevenness. A straightforward visual transformation algorithm is applied to address the unequal luminosity at the structural layer; it is used to enhance the details of the structure layer. The suggested methods were examined on public datasets (STARE, CHASEDB1, and DRIVE). To further confirm the recommended strategy's benefit in aiding the diagnosis, ophthalmologists' quality assessments were also taken. The objective evaluation used performance parameters such as GMSD, NIQE, HPSI, VSI, MCSD, and PSNR. According to experimental results, the suggested method may simultaneously manage the duties of illumination enhancement, details improvement, noise, and artifact suppression, outperforming state-of-the-art methods. According to the qualitative, quantitative, and statistical examination, the suggested algorithm reliably improves low-contrast retinal photos with intact color and a natural appearance. [ABSTRACT FROM AUTHOR]

With the increasing number of COVID-19 cases in the United States, more data is being reported on transmission, symptomatology, clinical course, and treatment of the virus. Research has focused on the trends and unique characteristics in at-risk populations, including pregnant women. This report summarizes the current data on considerations in pregnancy and postpartum period for mother and neonate to elucidate potential transmission risks for pediatric ophthalmologists. [ABSTRACT FROM AUTHOR]

The current coronavirus disease 2019 (COVID-19) pandemic is rapidly spreading around the world. The first doctor to report this new disease was an ophthalmologist: this exemplifies the role of ophthalmologists in an infectious disease pandemic. Here we review how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects the eye and discuss implications for ophthalmologists. [ABSTRACT FROM AUTHOR]

We present the case of a baby girl born at term with severe intrauterine growth restriction (IUGR) to a gravida 1 mother who was previously healthy and HIV negative. The newborn was evaluated by an ophthalmologist because of her history of IUGR and was diagnosed with intraretinal hemorrhages associated with areas of peripheral retinal necrosis at the posterior pole of both eyes. A diagnosis of acute retinal necrosis of presumed viral origin due to cytomegalovirus virus was considered, and the infant was started on and responded well to valganciclovir. [ABSTRACT FROM AUTHOR]

Abstract Oedipism is a rare but serious ophthalmologic and psychiatric emergency that usually occurs in patients with severe mental disorders such as schizophrenia and can be life-threatening. We report the case of bilateral oedipism in a 37 years old woman suffering from schizophrenia since the age of 16. Psychiatric exam revealed delusional syndrome whose main themes were erotomaniac, influence, possession, and persecution. She had auditory, visual hallucinations, and mental automatism syndrome. The patient was treated by clozapine and underwent twenty sessions of electroconvulsivotherapy. After three months of hospitalization, Miss I·F's condition has improved but she lost definitively her sight. This case illustrates a rare complication of a severe mental disorder. Advanced theories explaining this acting out are various. Its management should be multidisciplinary and should involve psychiatrists, ophthalmologists, and neurologists in order to detect any associated lesions. Highlights • To describe a rare phenomenon that is dangerous and could threaten the visual and the vital prognosis of the patient. • To insist on knowing predictive signs of the disease in order to prevent such dangerous acting-out. • To show that resistant schizophrenia could be serious and lead to harmful behaviors. [ABSTRACT FROM AUTHOR]

Purpose: To review contact lens prescribing trends in Japan between 2003 and 2016.Methods: An annual survey of contact lens prescribing trends was conducted each year between 2003 and 2016. Japanese ophthalmologists were asked to provide information relating to ten consecutive contact lens fittings between January and March every year.Results: Over the 14 years of the annual survey, data from a total of 64,122 contact lens fits were returned by ophthalmologists. The mean age (±SD) of lens wearers was 30 ± 13 years, and 68% were female. The proportion of rigid lens fits decreased over time, from 35.4% in 2003 to 14.7% in 2016. Across this period, daily disposable lens fits increased, representing 46% in 2016. The proportion of toric lenses and multifocal lenses gradually increased, from 6.6% and 1.9% to 12.3% and 5.8%, respectively. Silicone hydrogel material use grew from 0% to 43.2%, while mid and low water content lens materials declined from 54.1% and 28.2% to 36.1% and 8.3%, respectively. Multi-purpose lens care solutions dominated the market over the 14 year survey period.Conclusions: This survey has revealed prescribing trends and preferences in Japan over the past 14 years, with the main changes observed being a decrease in rigid lens use and an increase in the use of silicone hydrogel materials and daily disposable lenses. [ABSTRACT FROM AUTHOR]

Purpose Severe vision loss is a risk of orbital surgery which physicians should counsel patients about, but the overall risk rate is unknown. This research was conducted to determine the risk of severe vision loss related to orbital surgery. Design Retrospective review. Participants Patients who underwent orbital surgery at either of 2 academic medical centers between January 1994 and December 2014. Methods A billing database search was conducted to identify all patients who had orbital surgery during the study period, cross-checked against diagnostic codes related to vision loss. Charts were screened to determine baseline demographic and medical history, surgical procedure, intraoperative and perioperative management, and visual acuity. Patients with preoperative visual acuity ≥20/200 that worsened ≤20/400 after orbital surgery were included for detailed review. Statistical analysis was conducted to identify factors posing particular risk or benefit to visual outcome in these patients. Main Outcome Measures Visual acuity after orbital surgery. Results A total of 1665 patients underwent orbital surgery during the inclusion period, with 14 patients sustaining severe vision loss ranging from counting fingers at 1 foot to no light perception (overall risk, 0.84%). The causes of vision loss included retrobulbar hemorrhage, malpositioned implant, optic nerve ischemia, or direct optic nerve insult. When stratified by surgical approach, the risk of a blinding surgical complication was significantly higher for patients undergoing orbital floor repair in the setting of multiple facial fractures (subgroup risk, 6.45%), bony decompression of the optic canal (subgroup risk, 15.6%), or intracranial approach to the orbital roof (subgroup risk, 18.2%). Seven of 8 patients with a potentially reversible cause of postoperative vision loss underwent urgent repeat surgery, and 2 regained substantial vision (20/20 and 20/25). Administration of intravenous corticosteroids had no significant effect on visual acuity outcome. Conclusions The overall risk of severe vision loss after orbital surgery is 0.84%. The subgroup risk is higher in patients undergoing facial polytrauma repair, optic canal decompression, or orbital apex surgery from an intracranial approach. Close postoperative monitoring and urgent assessment and management of acute vision loss may improve visual outcome in some patients. [ABSTRACT FROM AUTHOR]

Purpose To describe characteristics of closed medical professional liability (MPL) claims against ophthalmologists in the United States. Design Retrospective analysis of MPL claims from 2006-2015. Data were obtained from the Physician Insurers Association of America (PIAA) Data Sharing Project (DSP). Comparison was made between ophthalmology and all healthcare specialties for physician demographics, prevalence and costs associated with closed claims, and resolution of claims. The most prevalent chief medical factor, presenting medical condition, operative procedure, outcomes, and resolution of ophthalmology claims were compared between the 2006-2010 and 2011-2015 periods. Participants From 2006-2015, 90 743 MPL claims were closed: 2.6% (2325/90 743) of closed claims and 2.2% (564/24 670) of all paid claims were against ophthalmologists. Methods Retrospective analysis of MPL claims captured by the PIAA DSP over a 10-year period. Main Outcome Measures Subspecialty pertaining to the claim, number of claims closed and paid, indemnity paid, allocated loss adjustment expenses, chief medical factor, presenting medical condition, operative procedure, outcome, and resolution. Results Only 24% of closed claims against ophthalmologists resulted in payment. Two-thirds were dropped, withdrawn, or dismissed. Ninety percent of claims that received a verdict were favorable toward the ophthalmologist. Cataract and cornea surgeries were the most prevalent and most costly operative procedures, accounting for 50% of all claims and $47 641 376 and $32 570 148 in total paid indemnity, respectively. Average indemnity was higher for corneal procedures ($304 476) than vitreoretinal procedures ($270 141) or oculoplastic procedures on the eyelid ($222 471) or orbit and eyeball ($183 467). The prevalence and cost of claims related to endophthalmitis declined from 2006-2010 (n = 38/1160 [3.3%]; average indemnity, $516 875) period to the 2011-2015 (n = 26/1165 [2.2%]; average indemnity, $247 083) period. Average indemnity paid ($280 227 vs. $335 578) and amount spent on legal defense ($41 450 vs. $46 391) was slightly lower among ophthalmologists compared with all healthcare specialties, respectively. Conclusions Ophthalmology has a relatively low number of malpractice claims reported compared with other healthcare specialties and shows less spending on average indemnity and defense. Further studies are needed to investigate the reasons for the higher prevalence of claims related to cataract and corneal surgeries and the higher average indemnity paid for corneal procedures relative to vitreoretinal or oculoplastic procedures. [ABSTRACT FROM AUTHOR]

Although rosacea is a common entity with significant cosmetic, socioeconomic, and vision-threatening impacts, this disorder remains incurable. Furthermore, until quite recently many of the therapeutic options for rosacea had not been assessed through rigorous clinical testing with meaningful outcome measures. Nonetheless, new medical and surgical interventions that have been validated in well-designed trials hold the promise of treating rosacea more effectively. Furthermore, recent enhancements in our understanding of the cellular and molecular biology offer highly translational insights that will hopefully lead to the development of new treatment options for rosacea. We review the evidence for these therapies and discuss new scientific findings that can be exploited for new therapeutic interventions. [ABSTRACT FROM AUTHOR]

Purpose ULISSE is the only study that prospectively assessed the efficiency of a standardized strategy, compared to an open strategy for the etiologic diagnosis of uveitis. Our aim was to evaluate the diagnostic yield of the tests prescribed in the ULISSE study to clarify their relevance. Methods ULISSE is a non-inferiority, prospective, multicenter and cluster randomized study. The standardized strategy is a two-steps strategy: in the first step, common standard tests were performed, and in the second step, tests were guided by the clinical and anatomic type of uveitis. We reported the relevance of the diagnostic tests used in the standardized strategy, as well as the profitability of the tests that were prescribed to more than twenty patients in each group. Based on diagnostic criteria, either an ophthalmologist, or an internist, established the profitability of a test by considering whether the test lead to a diagnosis or not. Results Among the 676 patients included (standardized 303; open 373), a diagnosis was made for 152 (50.4%) in the standardized group and 203 (54.4%) in the open group. The most common entities were HLA-B27 associated uveitis (22%), spondyloarthritis (11%), sarcoidosis (18%), tuberculosis (10.7%) and herpes virus infections (8.5%). Among the first step's systematic tests, tuberculin skin test was the most contributive investigation (17.1%), followed by chest X-ray (8.4%), C reactive protein and ESR (6.6% and 5.1%), complete blood count (2.2%) and VDRL (2.0%). The second step's most often contributive tests were: HLA B27 (56.3%), chest-CT (30.3%) and angiotensin converting enzyme (ACE) (16.5%). HLA B27 and ACE were significantly more contributive in the standardized group than in the open group. Immunological tests were never contributive. Among the free investigations, or among the investigations guided by clinical or paraclinical findings, the most often contributive tests were: Quantiferon® (24%), electrophoresis of serum protein (7.8%) and sacroiliac imagery (46.4%). Intracellular serologies (1.7%), serum calcium (2.1%) and hepatic tests (3.3%) were exceptionally contributive. Among the third intention tests, labial salivary gland biopsies were contributive in 17.9% of cases, but the profitability of other invasive investigations (anterior chamber tap, vitrectomy, bronchoscopy and lumbar puncture) or specialized imagery (18F-FDG PET, Brain MRI) could not be determined since these test were rarely performed. Conclusion Only a few diagnostic tests are useful for the etiological assessment of uveitis. They are often cheap, simple, more often guided by the clinical findings, and lead to an etiological diagnosis in most patients. On the other hand, some tests are never or exceptionally contributive, such as immunological tests or intracellular serologies. Further studies are required to evaluate the profitability of third intention imagery and invasive investigations. [ABSTRACT FROM AUTHOR]

Background Sarcoidosis is a systemic inflammatory disease which can involve nearly any organ. Clinically manifest cardiac involvement occurs in perhaps 5% of patients with sarcoidosis. The reported prevalence of isolated cardiac sarcoidosis (CS) varies widely with reported rates of 27–54%. The explanation for this variability is likely multi-factorial but perhaps mostly related to the diagnostic method(s) for assessing extra-cardiac involvement. The primary aim of this study was to assess the rate of isolated CS in a homogeneous, prospectively recruited cohort of patients with clinically manifest CS, using whole body FDG PET-CT imaging as a gold standard. A secondary aim was to describe the extent and distribution of extra-cardiac sarcoidosis at the time of first presentation of clinically manifest CS. Methods Patients were prospectively recruited at the time of first presentation with cardiac symptoms. All patients underwent whole-body and cardiac 18 F–FDG PET-CT. All patients were examined for presence of skin sarcoidosis and were assessed by an ophthalmologist. Results 31 patients were included (mean age 56 ± 8 years, 17 female, 100% Caucasian). Patients had limited extra-cardiac involvement (mean of 2.2 organs) however using the most precise definition, only 1/31 (3.2%) patients had isolated CS. There were marked differences in right ventricular (RV) and atrial involvement between patients presenting with CS as first presentation compared to patients presenting initially with extra-cardiac disease. Conclusions Most patients had limited extra-cardiac involvement at the time of presentation of manifest CS however, isolated CS, using the proposed gold standard, was only observed in one patient. [ABSTRACT FROM AUTHOR]

Purpose: Dry eye is known to impact on clinical outcomes after laser vision correction and the use of a newer 'all femtosecond laser' surgical approach may be associated with less impact on the ocular surface post-operatively. The purpose of this study was to evaluate the early clinical outcomes and tear instability after the first small incision lenticule extraction (SMILE) cases undertaken by three surgeons at a single site in the UK.Methods: Retrospective audit. Seventy-one eyes of 37 patients underwent SMILE surgery using the Zeiss VisuMax laser system (Carl Zeiss Meditec, Germany). Uncorrected and corrected distance visual acuity, spherical equivalent refraction, fluorescein enhanced tear break up time, simulated keratometry and complications were evaluated pre- and post-operatively where applicable.Results: The study population consisted of 21 males and 16 females. The mean±standard deviation age was 33±8years. The results showed that 100% of eyes achieved 20/40 or better and 88% achieved 20/20 or better uncorrected distance visual acuity. The spherical equivalent refraction after surgery was within ±0.50D in 82% of eyes at three months. There was no significant difference in tear break up time from pre-operative levels at three months. Complications were infrequent.Conclusions: This early data from surgeons' first SMILE procedures suggest SMILE provides good outcomes in terms of refractive predictability and visual acuity with minimal impact on the tear film. Longitudinal research will further improve our understanding of the longer-term impact of SMILE on clinical outcomes, ocular surface metrics and patient reported outcomes. [ABSTRACT FROM AUTHOR]