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Zaina Al-Mohtaseb,1 Scott Schachter,2 Bridgitte Shen Lee,3 Jaclyn Garlich,4 William Trattler5 1Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA; 2Presbyopia and Ocular Surface Disease, Allergan, an AbbVie Company, Irvine, CA, USA; 3Vision Optique, Houston, TX, USA; 4Envision Optometry, Boston, MA, USA; 5Center for Excellence in Eye Care, Miami, FL, USACorrespondence: Zaina Al-MohtasebDepartment of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, 6565 Fannin Street, Houston, TX, 77030, USATel +1-713-798-5143Fax +1-713-798-3027Email zaina@bcm.eduAbstract: Dry eye disease is characterized by tear film instability that can result in ocular surface damage. Patients with dry eye disease may experience ocular pain/discomfort and visual disturbances that may negatively impact quality of life. Increased use of digital screens for work, communication, and entertainment, especially during times of pandemic, may contribute to dry eye. Extensive cross-sectional studies have shown that digital screen use duration is associated with an increased risk of severe symptoms and clinical diagnosis of dry eye disease in adults. Smartphone use duration has also been found to be greater in school-age children with dry eye disease than in those without dry eye disease. A commonly accepted hypothesis for the relationship between digital screen use and dry eye disease is that digital screen use changes blinking dynamics, leading to ocular dryness. This review describes evidence that digital screen use is associated with dry eye disease, that digital device use alters blinking dynamics, and that dry eye affects mental health and work productivity in digital screen users. Helpful prevention and management strategies for dry eye disease exist for those who use digital screens.Keywords: blinking, ocular surface, quality of life, smartphone, computer, visual display

Weijie V Lin,1,* Megan N Scott,2,3,* Chosang Tendhar,4 Shazia F Ali,2,3 Zaina Al-Mohtaseb,2,3 Rizwan Shaikh,2,3 Christina Y Weng2,3 1School of Medicine, Baylor College of Medicine, Houston, TX, USA; 2Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA; 3Ben Taub General Hospital, Harris Health System, Houston, TX, USA; 4Office of Research, Assessment and Planning, Adelphi University, New York, NY, USA*These authors contributed equally to this workCorrespondence: Christina Y WengDepartment of Ophthalmology, Baylor College of Medicine, MBA Alkek Eye Center 1977 Butler Blvd., 3rd Floor, Houston, Texas 77030, USATel +1 713 798-6100Email christina.weng@bcm.eduObjective: To analyze outcomes and complications related to cataract surgery complicated by retained lens fragment (RLF) requiring pars plana vitrectomy (PPV) in a county hospital where procedures are performed by trainees.Methods: Retrospective study of consecutive patients who met inclusion criteria and underwent PPV for RLF in the vitreous cavity at an urban teaching hospital between January 2010 and January 2016 (N=20).Main Outcomes/Measures: Visual acuity was recorded pre- and post-operatively over a follow-up period of 3 to 12 months. Complications and patient factors contributing to outcomes were assessed using paired and unpaired t-tests and multiple linear regression.Results: The average rate of cataract surgery with RLF requiring PPV was 0.75%. Twenty patients met inclusion criteria. Mean pre-operative visual acuity (VA) was logMAR 1.7 (Snellen 20/1000). Nearly half (8/20) had nuclear cataracts grade 3+ or higher. The majority (14/20) had factors predisposing them to cataract surgery complications. Most patients underwent PPV within 1 week (median 6.5 days). At 12-month follow-up, significant (p=0.001) visual acuity (VA) improvement from initial VA was observed, with final mean logMAR 0.6 (± 0.75; Snellen 20/80) and median logMAR 0.35 (Snellen 20/45). Nearly half of the patients had a final Snellen VA ≥ 20/40. Factors associated with less VA improvement were older age and greater proportion of lens dropped (p< 0.01). Complications following PPV included hypotony (5 patients), corneal edema (4), elevated intraocular pressure (IOP) (3), and cystoid macular edema (3).Conclusions/Relevance: Despite patients with advanced pathology and trainee surgeons, rates of cataract surgery-associated RLF requiring PPV at a large tertiary care teaching hospital are similar to reported rates in the literature.Keywords: trainee, complicated cataract surgery, retained lens fragments, resident, fellow, pars plana lensectomy, pars plana vitrectomy, teaching, surgical education

Background  The extent and impact of ophthalmology resident scholarly output is not well known. The authors aim to quantify scholarly activity of ophthalmology residents during residency and assess what factors may be associated with greater research productivity of these residents. Material and Methods  Ophthalmology residents who graduated in 2021 were identified from their respective program Web sites. Bibliometric data published by these residents between the beginning of their postgraduate year 2 (July 1, 2018) until 3 months after graduation (September 30, 2021) were captured through searches via PubMed, Scopus, and Google Scholar. The association of the following factors with greater research productivity numbers was analyzed: residency tier, medical school rank, sex, doctorate degree, type of medical degree, and international medical graduate status. Results  We found 418 ophthalmology residents from 98 residency programs. These residents published a mean (±standard deviation [SD]) number of 2.68 ± 3.81 peer-reviewed publications, 2.39 ± 3.40 ophthalmology-related publications, and 1.18 ± 1.96 first-author publications each. The mean (±SD) Hirsch index (h-index) for this cohort was 0.79 ± 1.17. Upon multivariate analysis, we discovered significant correlations between both residency tier and medical school rank and all bibliometric variables assessed. Pairwise comparisons revealed that residents from higher tier programs had greater research productivity numbers than those from lower tier programs. Conclusion  We obtained bibliometric standards for ophthalmology residents on a national scale. Residents who graduated from higher-ranked residency programs and medical schools possessed higher h-indices and published more peer-reviewed publications, ophthalmology-related articles, and first-author publications., Competing Interests: Conflict of Interest None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

In the absence of capsular support, it is not always possible to safely place an intraocular lens (IOL) in the capsular bag at the time of surgery. Several techniques have thus been developed to enable safe placement of a secondary IOL outside the capsular bag. These techniques include placement of anterior chamber IOLs, iris-fixated IOLs (sutured, iris-claw), and scleral-fixated IOLs (sutured, sutureless). Secondary IOL placement can take place at the time of the initial surgery or in a second surgery. Each technique has its own unique advantages, as well as its potential complications. At this time, comparison studies have found no secondary IOL technique to be superior in terms of visual acuity or rate of complications. Additional comparison studies with longer follow-up times are needed to confirm these findings. The decision on which secondary IOL technique to perform depends on numerous factors including surgeon experience and comfort, as well as patient comorbidities., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Saudi Journal of Ophthalmology.)

Purpose: To determine statewide cataract surgery rates with cataract extraction with intraocular lens implantation (CEIOL) in Florida from 2005 to 2014 among Caucasians, African-Americans, Hispanics, and Asian/Pacific Islanders., Methods: This is a retrospective database study analyzing ambulatory surgical data in Florida from 2005 to 2014. Using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project (HCUP) and State Ambulatory Surgery and Services Databases (SASD), the authors utilized data mining algorithms to analyze and graphically represent disparities in the delivery of cataract surgery, changes in surgery volume, and demographic characteristics in patients 65 years and older in all Florida counties from 2005 to 2014., Results: Cataract surgeries performed in patients ≥65 years of age represented 1,892,132 (14.90%) of the 12,695,932 total ambulatory surgical procedures from 2005 to 2014 in the HCUP-SASD Florida database. More surgeries were performed in females versus males, P < 0.001. Caucasians, African-Americans, and Hispanics represented 82.23%, 4.95%, and 10.69% of the utilization rate of all CEIOLs, respectively. From 2005 to 2014, the average surgery volume increased by an average rate of change of 1.29%. Cataract surgery penetration in the general population observed a steady decrease from 18.82% in 2005 to 16.66% in 2014., Conclusions: Cataract surgery in Florida exhibited an unequal distribution with respect to gender and race, and select counties exhibited marked changes in surgical volume over the past 11 years. This study establishes a method for data mining and geospatial analysis to study surgical and epidemiological trends and identify disparities in delivery of healthcare., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Current Ophthalmology.)

To assess the repeatability and comparability of the Galilei G4 versus the Cassini topographer in post-refractive eyes and in normal eyes, including older patients representative of an initial cataract evaluation. Simulated keratometric (simK), total corneal and posterior corneal power and astigmatism were evaluated in both post-refractive and normal eyes. Repeatability was measured by calculating within-subject standard deviation (Sw), coefficient of variation (CoV), and intraclass correlation coefficient (ICC). Vector analyses and Bland-Altman plots were employed to assess agreement between devices. We studied 32 subjects with a history of refractive surgery and 32 subjects without a history of refractive surgery undergoing cataract surgery. The mean age was 55 ± 18.5 years and the age range was 21.5-91.5 years. In non-refractive and post-refractive eyes, the ICC was > 0.9 (P < 0.001) for all corneal powers and for simK and total corneal astigmatism for both analyzers. The ICC for posterior corneal astigmatism magnitude using the Galilei was 0.62 and 0.67 and for the Cassini 0.55 and 0.38 in normal and post-refractive eyes, respectively. In both post-refractive and normal eyes, the Galilei G4 and Cassini analyzers have high repeatability in simK, total, and posterior corneal power and low repeatability for posterior corneal astigmatism., (© 2021. The Author(s).)

Purpose: To report a case of ocular cystinosis diagnosed by anterior segment optical coherence tomography (AS-OCT) and histopathology., Methods: A 67-year-old man who presented with eye pain was found to have unilateral corneal crystal deposition. Ocular cystinosis was diagnosed by histopathology, AS-OCT, and lack of renal involvement of the disease., Results: AS-OCT showed hyperreflective densities in the corneal epithelium. The patient underwent superficial keratectomy given irregular astigmatism prior to cataract surgery. Electron microscopy of the corneal scrapings revealed epithelial cells with intracystoplasmic membrane-bound crystals confirming the diagnosis of cystinosis., Conclusion: To our knowledge, this is the first reported case of ocular cystinosis involving strictly the epithelial layer of the cornea that has been imaged by AS-OCT.