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We hypothesize that artificial intelligence (AI) applied to relevant clinical testing in glaucoma has the potential to enhance the ability to detect glaucoma. This premise was discussed at the recent Collaborative Community on Ophthalmic Imaging meeting, "The Future of Artificial Intelligence-Enabled Ophthalmic Image Interpretation: Accelerating Innovation and Implementation Pathways," held virtually September 3-4, 2020. The Collaborative Community on Ophthalmic Imaging (CCOI) is an independent self-governing consortium of stakeholders with broad international representation from academic institutions, government agencies, and the private sector whose mission is to act as a forum for the purpose of helping speed innovation in healthcare technology. It was 1 of the first 2 such organizations officially designated by the Food and Drug Administration in September 2019 in response to their announcement of the collaborative community program as a strategic priority for 2018-2020. Further information on the CCOI can be found online at their website (https://www.cc-oi.org/about). Artificial intelligence for glaucoma diagnosis would have high utility globally, because access to care is limited in many parts of the world and half of all people with glaucoma are unaware of their illness. The application of AI technology to glaucoma diagnosis has the potential to broadly increase access to care worldwide, in essence flattening the Earth by providing expert-level evaluation to individuals even in the most remote regions of the planet.

PURPOSE: To assess the prevalence of near and correctable distance visual impairment among screened participants in the garment industry and to explore associations with income, age, and urban versus rural residence.METHODS: Vision screenings were conducted at 4 garment factories, 2 urban and 2 rural locations during September and October 2019. Distance vision impairment was the presence of uncorrected vision of 6/12 in the same eye; 2) having been prescribed near add spectacle power in examination records; and/or 3) clinical diagnosis of presbyopia at the time of screening. Demographic information and monthly income were self-reported by questionnaire completion.RESULTS: Among 915 participating workers (100% female, 18 to 70 years), 29.2% (n = 267) and 26.8% (n = 245) had correctable distance and near vision impairment respectively. Prevalence of near vision impairment was significantly higher among rural residents (34.2%, n = 160), compared to urban (19.0%, n = 85, P CONCLUSIONS: This study found high rates of near vision impairment among female garment workers, particularly rural dwellers, and at a younger age than expected. The high prevalence and association between near vision impairment and lower income suggest that focusing on industries with a high proportion of female workers, such as readymade garments, may be effective in addressing gender disparities in vision impairment and its economic impact.

Background There is a growing awareness that addressing chronic as well as acute health conditions may contribute importantly to the well-being of displaced populations, but eye care service has generally not been prioritized in crisis situations. We describe a replicable model of eye care provision as delivered by Orbis International and local partners to the Rohingya and host population in Cox’s Bazar, Bangladesh, and characterize the burden of vision impairment and demand for sight-restoring services in this setting. Methods and findings Orbis International and local secondary facility Cox’s Bazar Baitush Sharaf Hospital (CBBSH) provide eye care support to the Rohingya population and the host community of all ages in Cox’s Bazar, Bangladesh, with fixed vision screening locations established in Camps 4 and 11 of the Kutupalong refugee settlement. Structured outreach targets these camps and four surrounding local subdistricts, with referrals made as needed for refraction (glasses measurement) and cataract surgery to CBBSH. Between February 2018 and March 2019, 48,105 displaced Rohingya (70.3%, among whom 71.6% were children and 46.5% women) and 20,357 local residents (29.7%, 88.5% children, 54.4% women) underwent vision screening. Displaced Rohingya sought services from a total of 12 surrounding camps, within which coverage was 17.3%, including 43.3% (27,027/62,424) of children aged 5–11 years and 60.0% (5,315/8,857) of adults ≥ 60 years old. The prevalence of blindness (presenting acuity < 3/60) among Rohingya patients exceeded that among local residents by 3- to 6-fold in each 10-year age group between 18 and 59 years (P < 0.001 comparing vision between the two groups in this age range), and the prevalence of cataract requiring surgery was also higher in Rohingya patients (18–29 years: 4.67% versus 1.80%, P = 0.0019; 30–39: 7.61% versus 2.39%, P < 0.001; and 40–49 years: 7.91% versus 3.77%, P = 0.0014). A limitation of the study is lack of data on population prevalence of eye disease. Conclusions The burden of untreated eye disease is very high among the Rohingya, particularly those in their peak working years who could contribute most to the resiliency of their community. Demand for eye care service is also great among children and adults in this population with many competing healthcare priorities. Research is needed, building on strong evidence of benefit in settled populations, to explore the specific impact of vision care on the well-being of displaced populations., Danny Hadad et al report the burden of untreated vision impairment among the Rohingya people in Cox's Bazar, Bangladesh., Author summary Why was this study done? It is increasingly acknowledged that addressing non-emergent health problems can improve the resilience of displaced communities and that such populations can suffer significant burdens of vision impairment. However, few if any studies have systematically assessed the demand for eye care in conflict or crisis situations, and models to deliver vision services in such settings have rarely been documented. What did the researchers do and find? Between February 2018 and March 2019, 48,105 displaced Rohingya and 20,357 local residents underwent vision screening. Coverage in the population was 43.3% (27,027/62,424) among children aged 5–11 years and 60.0% (5,315/8,857) among adults ≥ 60 years old. Prevalence of blindness (presenting acuity < 3/60) among Rohingya patients exceeded by 3- to 6-fold that among local residents between 18 and 59 years old. What do these findings mean? The burden of untreated eye disease is very high among the Rohingya, particularly those in the peak working years who could contribute most to the resiliency of their community. Demand for eye care service is great among children and adults in this population with many competing healthcare priorities.

Purpose: To describe a process for identifying birth weight (BW) and gestational age (GA) screening guidelines in Mongolia. Methods: This was a prospective cohort study in a tertiary care hospital in Ulaanbataar, Mongolia, of 193 premature infants with GA of 36 weeks or younger and/or BW of 2,000 g or less) with regression analysis to determine associations between BW and GA and the development of retinopathy of prematurity (ROP). Results: As BW and GA decreased, the relative risk of developing ROP increased. The relative risk of developing any stage of ROP in infants born at 29 weeks or younger was 2.91 (95% CI: 1.55 to 5.44; P < .001] compared to older infants. The relative risk of developing any type of ROP in infants with BW of less than 1,200 g was 2.41 (95% CI: 1.35 to 4.29; P = .003] and developing type 2 or worse ROP was 2.05 (95% CI: 0.99 to 4.25; P = .05). Conclusions: Infants in Mongolia with heavier BW and older GA who fall outside of current United States screening guidelines of GA of 30 weeks or younger and/or BW of 1,500 g or less developed clinically relevant ROP. [ J Pediatr Ophthalmol Strabismus . 2020;57(5):333–339.]

As the world continues to become more connected by technology, commerce, and international travel, it is critical for all healthcare professionals to understand the growing role of global health and to learn from this dynamic field. The definition of “global health” continues to evolve as new challenges, regulations, and innovations are constantly emerging which may add new dimensions (and solutions) to already complex health and social issues around the world. Healthcare professionals with this interest may look for opportunities to study these issues formally in master’s degree or certificates in global health, to see how their research could impact global populations, and to work abroad on the ground. This chapter is designed to give a general overview of the key components of global health and the important aspects of this field to consider when looking at a practice and career in global health.

BACKGROUND: Presbyopia, age-related decline in near vision, is the most common cause of vision impairment globally, but no trials have assessed its workplace effects. We aimed to study the effect of near glasses on the productivity of tea workers with presbyopia.METHODS: This randomised trial was done in tea pickers aged 40 years or older in Assam, India, with unaided near visual acuity (NVA) lower than 6/12 in both eyes, correctable to 6/7·5 with near glasses; unaided distance vision 6/7·5 or greater; and no eye disease. Participants were randomly assigned (1:1) to receive free glasses optimising NVA at working distance (cost including delivery US$10·20 per person), either immediately (intervention group) or at closeout (control group). Participants were stratified by age, sex, and productivity. The primary outcome (investigator-masked) was the difference between groups in the change in mean daily weight of tea picked (productivity), between the 4-week baseline period (June, 2017) and the 11-week evaluation period (July 24, 2017, to Oct 7, 2017). Workers' income was tied to their productivity. Compliance with study glasses was assessed at seven unannounced visits. Results were analysed on an intention-to-treat basis. This trial is registered with ClinicalTrials.gov, number NCT03228199.FINDINGS: Between July 3, 2017, and July 15, 2017, 1297 (48·1%) of 2699 permanent workers met the age criteria and consented for eye examinations. 751 (57·9%) fulfilled vision criteria and were randomly assigned to the intervention (n=376) or control (n=375) groups. Groups did not differ substantially in baseline characteristics. No participants owned glasses at baseline, 707 (94·1%) received the allocated intervention, and all were followed up and analysed. Between the baseline and evaluation periods, mean productivity in the intervention group increased from 25·0 kg per day to 34·8 kg per day (an increase of 9·84 kg per day), a significantly higher increase than in the control group (from 26·0 kg per day to 30·6 kg per day; an increase of 4·59 kg per day), corresponding to a between-group difference of 5·25 kg per day (95% CI 4·50-5·99; 21·7% relative productivity increase; effect size 1·01 [95% CI 0·86-1·16]; pINTERPRETATION: A substantial productivity increase was achieved in this rural cohort by providing glasses to correct presbyopia, with little cost and high intervention uptake.FUNDING: Clearly.

This study was undertaken to measure the effect of telemedicine consultation for diagnosis and treatment planning in cases of strabismus. Telemedicine consultation records of all patients on ORBIS Telemedicine Cyber-Sight that resulted in a final diagnosis of superior oblique palsy (SOP), Duane syndrome (DS), and Brown syndrome (BS) were collected. The following were then determined: (1) the clinical characteristics of patients in each category, (2) the diagnosis submitted by the doctor requesting consultation compared to the diagnosis determined by the mentor, and (3) the treatment plan submitted with the consultation request compared to the mentor's suggested plan. The clinical characteristics of patients with SOP, DS, and BS were similar to those reported in the literature. There were 89 with SOP, 131 with DS, and 50 with BS. Partners and mentors agreed on the diagnosis of SOP in 81% of cases, DS in 79% of cases, and BS in 72% of cases. Mentors agreed with the partners' proposed treatment plan in SOP 35%, DS 55%, and BS 52%. Mentors are likely to change the diagnosis proposed by doctors seeking consultation for strabismus in 25% of cases and provide a new treatment plan in more than 50% of cases. The clinical characteristics of those strabismus entities selected matched those found in the literature, making it likely that the cases as viewed on telemedicine presented a true clinical picture.

Zhe-Yi Eye Centre, Hang Zhou, ORBIS, Second Affiliated Hospital of Harbin Medical University, China, LV Prasad Eye Institute, India and Department of Ophthalmology and Vision Sciences, University of Toronto and The Hospital for Sick Children, Canada Correspondence to Dr Agnes M.F. Wong, MD, PhD, FRCSC, Department of Ophthalmology and Vision Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada Tel: + 1 416 813 7654 x2642; fax: + 1 416 813 5159; e-mail: agnes.wong@utoronto.ca

It is remarkable to uncover a new aspect of congenital epibulbar solid dermoids and lipodermoids. We describe a dramatic central epicorneal polypoidal lipodermoid coloboma accompanied by an upper eyelid coloboma that was not associated with Goldenhar syndrome. Histopathologically the excised lesion displayed superficial layers of epidermis and a thin dermis with eccrine glands, vestigial hair structures, and bundles of arrector pili smooth muscle that extended from the undersurface of the epidermis to the bulge area of the primitive hairs. This last feature is not present in normal eyelid skin nor in the conjunctiva, and has not been previously documented to occur in epibulbar dermoids and lipodermoids. S-100-positive dendritic melanocytes and CD1a-positive Langerhans cells were both observed intraepidermally, indicating a complete complement of normal cells in this layer. Beneath the dermis was a massive collection of lobules of mature adipose tissue that fused with the corneal stroma. A virtually identical pedunculated limbal tumor has been previously reported that was associated with Goldenhar syndrome. Review of earlier published cases of epibulbar dermoids and lipodermoids establishes that central corneal lesions are not a stigma of Goldenhar syndrome, in contrast to limbal masses. Other epibulbar choristomas that can be confused with lipodermoids are described.

Background and Objective:To compare the utility and accuracy of high-precision immersion ultrasound, partial coherence interferometry, and the IOL Master system (Carl Zeiss Meditec, Dublin, CA) in a tertiary care referral center.Patients and Methods:Comparative clinical study in a tertiary care, multispecialty, university practice. Participants were consecutive patients scheduled for cataract surgery at Emory Eye Center. Patients underwent biometry using immersion ultrasound, partial coherence interferometry, and the IOL Master system.Results:Twenty-two percent of eyes undergoing surgery could not be measured using interferometry. In those eyes measurable by both methods, there was no difference in measurements nor postoperative refractive outcome. Each method had a high repeatability (intraclass correlation coefficient > 0.99) with a high intraclass correlation between methods (intra-class correlation coefficient = 0.99).Conclusions:When it can be used, interferometry is equivalent to immersion ultrasonography regarding biometric accuracy and precision. However, it cannot replace ultrasonography, especially for eyes with dense media opacity.

Hind-limb ischemia is a potent stimulus for angiogenesis. However, capillary density does not change in tibialis anterior muscle (TA) following hind-limb ischemia, despite increases in angiogenic growth factors. The objective of this study was to determine whether changes in proliferation and apoptosis occurred in the same muscle. In total, 19 New Zealand white rabbits underwent femoral artery ligation and excision and the ischemic and contra-lateral (control) TA muscles were harvested after 1 (n = 7), 5 (n = 7) and 21 (n = 5). Terminal deoxynucleotidyltransferase-mediated dUTP nick-end labeling (TUNEL) was used to detect apoptosis and double staining was used to identify the apoptotic cell types. Proliferation was assessed by immunohistochemistry for proliferating cell nuclear antigen (PCNA) and [3H]thymidine incorporation, in vitro. TUNEL positive nuclei were greater in ischemic than control muscle at 1 day (1.83 0.70% vs 1.03 0.20%), 5 days (2.13 0.50% vs 1.21 0.42%) and at 21 days the difference was statistically significant (3.42 0.80% vs 0.96 0.40%, p 0.01). The majority of TUNEL positive nuclei were endothelial (Tie2 positive) cells. The number of PCNA positive cells in ischemic versus control muscle was similar at 1 day (0.71 0.20% vs 0.53 0.20%) and 5 days (1.28 0.30% vs 0.77 0.30%), but was significantly (p 0.05) reduced in ischemic muscle at 21 days (0.18 0.20% vs 1.35 0.30%) with no difference in [3H]thymidine incorporation. Directionally opposite changes in endothelial cell proliferation and apoptosis occur in TA muscle following hind-limb ischemia. Modulating apoptosis in ischemic skeletal muscle may present a novel therapeutic target in peripheral arterial disease.

Objectives To analyze outcomes of resident-performed phacoemulsifications and to assess the resident phacoemulsification learning curve. Methods Retrospective chart review of resident-performed phacoemulsification cases at the Atlanta Veterans Affairs Medical Center, Decatur, Georgia, from July 1, 1999, through June 30, 2002. Outcomes measured included postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), intraoperative complications, and adjusted phacoemulsification times (total phacoemulsification time multiplied by phacoemulsification power used). Results We analyzed 680 cases. Postoperative mean UCVA was 20/39, and mean BSCVA was 20/25 (≥ 20/20 in 44.0% of cases and ≥ 20/40 in 97.8%). There were no differences in visual acuity outcomes over the course of residency training. Intraoperative complications occurred in 34 cases (5.0%), with a significant reduction in vitreous loss rates after the first 80 resident cases (5.1% vs 1.9%; P = .03). Mean adjusted phacoemulsification time was 0.68 minutes, with a significant reduction in adjusted phacoemulsification time after the first 80 cases (0.87 vs 0.52 minutes; P Conclusions Quality visual outcomes after phacoemulsification can be attained throughout residency training; however, surgical competency, when measured by complication rates and phacoemulsification efficiency, continues to improve significantly with increasing surgical experience well beyond the first 80 resident phacoemulsification cases.

A woman with pulmonary hypertension presented with shortness of breath and changes in mental status.