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Ravenstijn M, Jansen RC, du Bois G, Yzer S, Klaver CCW. Empowering patients with high myopia: The significance of education. Acta Ophthalmol 2024; 102:357-363. [PMID: 37899508 DOI: 10.1111/aos.15779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 10/31/2023]
Abstract
PURPOSE To investigate the status of patient education among highly myopic individuals focusing on the presence, sources, content, timing of the education and impact on patients. METHODS Self-reported data were collected through an online 13-item questionnaire consisting of open and multiple-choice questions. The questionnaire was sent to 250 highly myopic members of a patient organization in the Netherlands, of whom 128 (51%) responded. RESULTS At least one acute event had occurred in 66% (84/128) of participants at the time of the questionnaire. Among all participants, 25% (32/128) had not received patient education regarding alarm symptoms for any of these events. Among those who had been informed, the ophthalmologist was the most frequent (57%, 73/128) source of information. Participants who visited the ophthalmologist annually were more frequently informed than participants without annual visits (53%, 26/49 versus 26%, 9/35, p = 0.002). Those not informed were more likely to have a more than 3 days patient delay (92%, 12/13). Doctors delay was also present; 26% (22/84) of the participants with alarm symptoms had to wait 2 or more days before the first appointment. Long-term consequences of myopia had been discussed with 102 participants (80%, 102/128), again with the ophthalmologist as the most frequent source (59%, 76/128). PERSPECTIVES Many myopic individuals have not been educated about their increased risk of acute events, which can result in patient delay and serious consequences with respect to visual prognosis. These findings underscore the critical importance of integrating patient education across the entire ophthalmic care chain for myopia.
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Affiliation(s)
- M Ravenstijn
- Rotterdam Ophthalmic Institute, Rotterdam Eye Hospital, Rotterdam, The Netherlands
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R C Jansen
- Oogvereniging, Utrecht, The Netherlands
- Groningen Bioinformatics Centre, University of Groningen, Groningen, The Netherlands
| | - G du Bois
- Oogvereniging, Utrecht, The Netherlands
| | - S Yzer
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C C W Klaver
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland
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Swaminathan VB, Salabati M, Israilevich R, Cehelyk E, Mahmoudzadeh R, Uhr JH, Spirn MJ, Klufas MA, Garg SJ, Hsu J. Outcomes following repair of early-onset versus delayed-onset rhegmatogenous retinal detachments after acute posterior vitreous detachment. Br J Ophthalmol 2024; 108:552-557. [PMID: 36918274 DOI: 10.1136/bjo-2022-322530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
AIM To report anatomical and functional outcomes after surgical repair of acute-onset vs delayed-onset rhegmatogenous retinal detachments (RDs) following acute posterior vitreous detachment (PVD). METHODS A retrospective, comparative interventional cohort study where patients presenting to a single-centre retina practice between October 2015 and March 2020 with delayed RDs (diagnosed ≥42 days after initial presentation of acute PVD) were compared with a 2:1 age-matched and gender-matched acute RD cohort (PVD and RD at initial presentation). The primary outcome was the final attachment rate and single surgery anatomic success (SSAS) at 3 months after RD repair. RESULTS A total of 210 eyes were analysed-70 in the delayed RD group and 140 in the acute RD group. SSAS was 58/70 (82.9%) for the delayed RD group and 112/140 (80%) for the acute RD group (p=0.71). At the time of RD diagnosis, mean (SD) logarithm of minimum angle of resolution visual acuity (VA) was 0.51 (0.70) (Snellen, 20/65) in the delayed RD group vs 1.04 (0.92) (Snellen, 20/219) in the acute RD group (p<0.001). Mean VA was better at 1 and 3 months post-repair in the delayed RD group (p=0.005 and 0.041, respectively) but similar by 6 months, 12 months and at the final visit post-repair (p=0.48, 0.27, and 0.23, respectively). CONCLUSIONS Delayed-onset RDs occurring ≥6 weeks after initial presentation to a retina specialist with an acute PVD generally had better VA at the time of RD diagnosis and faster post-surgical visual recovery compared with acute-onset RDs diagnosed at the initial presentation. No significant difference in anatomic outcomes was seen between the two groups.
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Affiliation(s)
| | - Mirataollah Salabati
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Rachel Israilevich
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eli Cehelyk
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Raziyeh Mahmoudzadeh
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Joshua H Uhr
- University of Miami Health System, Bascom Palmer Eye Institute, Miami, Florida, USA
| | - Marc J Spirn
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Michael A Klufas
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Sunir J Garg
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
| | - Jason Hsu
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- The Retina Service, Wills Eye Hospital, Wills Eye Physicians-Mid Atlantic Retina, Philadelphia, Pennsylvania, USA
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Chu KO, Yip YWY, Chan KP, Wang CC, Ng DSC, Pang CP. Amelioration of Functional, Metabolic, and Morphological Deterioration in the Retina following Retinal Detachment by Green Tea Extract. Antioxidants (Basel) 2024; 13:235. [PMID: 38397833 PMCID: PMC10886023 DOI: 10.3390/antiox13020235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/09/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024] Open
Abstract
Retinal detachment (RD) can result in the loss of photoreceptors that cause vision impairment and potential blindness. This study explores the protective effects of the oral administration of green tea extract (GTE) in a rat model of RD. Various doses of GTE or epigallocatechin gallate (EGCG), the most active ingredient in green tea catechins, were administered to Sprague Dawley (SD) rats with experimentally induced retinal detachment. The rats received sub-retinal injections of hyaluronic acid (0.1%) to induce RD and were given different doses of GTE and EGCG twice daily for three days. Notably, a low dose of GTE (142.9 mg/kg) caused significantly higher signal amplitudes in electroretinograms (ERGs) compared to higher GTE doses and any doses of EGCG. After administration of a low dose of GTE, the outer nuclear layer thickness, following normalization, of the detached retina reduced to 82.4 ± 8.2% (Mean ± SEM, p < 0.05) of the thickness by RD treatment. This thickness was similar to non-RD conditions, at 83.5 ± 4.7% (Mean ± SEM) of the thickness following RD treatment. In addition, the number of TUNEL-positive cells decreased from 76.7 ± 7.4 to 4.7 ± 1.02 (Mean ± SEM, p < 0.0001). This reduction was associated with the inhibition of apoptosis through decreased sphingomyelin levels and mitigation of oxidative stress shown by a lowered protein carbonyl level, which may involve suppression of HIF-1α pathways. Furthermore, GTE showed anti-inflammatory effects by reducing inflammatory cytokines and increasing resolving cytokines. In conclusion, low-dose GTE, but not EGCG, significantly alleviated RD-induced apoptosis, oxidative stress, inflammation, and energy insufficiency within a short period and without affecting energy metabolism. These findings suggest the potential of low-dose GTE as a protective agent for the retina in RD.
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Affiliation(s)
- Kai On Chu
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (K.O.C.); (Y.W.Y.Y.); (K.P.C.)
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China;
| | - Yolanda Wong Ying Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (K.O.C.); (Y.W.Y.Y.); (K.P.C.)
| | - Kwok Ping Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (K.O.C.); (Y.W.Y.Y.); (K.P.C.)
| | - Chi Chiu Wang
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China;
| | - Danny Siu Chun Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (K.O.C.); (Y.W.Y.Y.); (K.P.C.)
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China; (K.O.C.); (Y.W.Y.Y.); (K.P.C.)
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Curran CD, Adams OE, Vagaggini T, Sodhi GS, Prairie ML, Baker MJ, Sastry A, Ryan EH, Parke DW, Mittra RA, Dev S, Tang PH. PROPHYLACTIC TREATMENT OF LATTICE DEGENERATION IN FELLOW EYES AFTER REPAIR OF UNCOMPLICATED PRIMARY RHEGMATOGENOUS RETINAL DETACHMENT. Retina 2024; 44:63-70. [PMID: 37536462 DOI: 10.1097/iae.0000000000003908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
PURPOSE To evaluate prophylactic treatment (PTx) of lattice degeneration (LD) on retinal tear (RT) and rhegmatogenous retinal detachment (RRD) risk in fellow eyes of patients after primary RRD repair in the first eye. METHODS This was a consecutive case series with cohort control involving patients with RRD repair from January 1, 2013, through December 31, 2017. Patients received PTx (PTx cohort) or no PTx (No-PTx cohort) in fellow eye with 5-year follow-up. Primary outcome measure was proportion with new fellow eye RT/RRD. Secondary outcomes included logarithm of minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) and status of myopia, posterior vitreous detachment, and pseudophakia. RESULTS Four hundred ninety-eight patients were divided into 146 and 352 in PTx and No-PTx cohorts, respectively. PTx cohort developed significantly ( P < 0.05) fewer RT/RRD (17%) than No-PTx cohort (41%). PTx significantly ( P < 0.05) lowered RT/RRD irrespective of posterior vitreous detachment and myopia status. PTx patients undergoing phacoemulsification demonstrated significantly ( P < 0.05) less RT/RRD (22%) than No-PTx cohort (31%). There was no significant ( P = 0.96) final BCVA difference between PTx (median = 0 logMAR) and No-PTx (median = 0 logMAR) cohorts. CONCLUSION PTx of asymptomatic fellow eye LD reduced RT/RRD risk.
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Affiliation(s)
- Christian D Curran
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Olufemi E Adams
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
| | | | | | | | - Mikayla J Baker
- University of Minnesota Medical School, Minneapolis, Minnesota; and
| | - Ananth Sastry
- Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Edwin H Ryan
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - David Wilkin Parke
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Robert A Mittra
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Sundeep Dev
- Retina Consultants of Minnesota, Edina, Minnesota
| | - Peter H Tang
- Department of Ophthalmology & Visual Neurosciences, University of Minnesota Medical School, Minneapolis, Minnesota
- Retina Consultants of Minnesota, Edina, Minnesota
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Govers BM, Keijser S, El Kandoussi M, van Overdam KA, Klevering BJ, Crama N. The effect of patient symptom awareness on the visual outcome in retinal detachment. Acta Ophthalmol 2023. [PMID: 38009800 DOI: 10.1111/aos.15815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE To explore whether a patient's prior knowledge of the symptoms associated with rhegmatogenous retinal detachment (RRD) relates to the visual outcome after treatment. METHODS We performed a prospective survey study on 126 patients receiving treatment for primary RRD between March and July 2021. RESULTS Thirty-seven per cent (n = 47) of patients responded that they were aware of the RRD symptoms prior to the detachment. A history of RRD in the fellow eye or knowledge of family members treated for RRD was frequently reported as a reason for the patient's awareness of RRD symptoms. Patients aware of RRD symptoms presented significantly more often with an attached macula (χ2 , p = 0.002) and a better visual outcome following surgery (Mann-Whitney U, p = 0.028) compared to patients who were not aware of RRD-related symptoms. Among 76 patients with a myopic refractive error, only 15% (n = 11) indicated that they had been warned about the increased RRD risk related to myopia, suggesting that three-quarters of patients were not actively informed by their eye care professionals. CONCLUSION RRD symptom awareness is significantly related to a higher rate of macula-on RRDs and better visual outcomes after treatment. There is limited awareness of increased RRD risk in myopic RRD patients. These findings suggest that counselling individuals at high risk of RRD about related symptoms is inadequate and better counselling may improve visual outcomes following RRD treatment.
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Affiliation(s)
- B M Govers
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - S Keijser
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - M El Kandoussi
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - K A van Overdam
- Department of Ophthalmology, Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - B J Klevering
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - N Crama
- Department of Ophthalmology, Radboud University Medical Centre, Nijmegen, the Netherlands
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Yadav S, Murugan R, Goel T. H-Deep-Net: A deep hybrid network with stationary wavelet packet transforms for Retinal detachment classification through fundus images. Med Eng Phys 2023; 120:104048. [PMID: 37838406 DOI: 10.1016/j.medengphy.2023.104048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/05/2023] [Accepted: 09/04/2023] [Indexed: 10/16/2023]
Abstract
Nowadays, automated disease diagnosis has become a vital role in the medical field due to the significant population expansion. An automated disease diagnostic approach assists clinicians in the diagnosis of disease by giving exact, consistent, and prompt results, along with minimizing the mortality rate. Retinal detachment has recently emerged as one of the most severe and acute ocular illnesses, spreading worldwide. Therefore, an automated and quickest diagnostic model should be implemented to diagnose retinal detachment at an early stage. This paper introduces a new hybrid approach of best basis stationary wavelet packet transform and modified VGG19-Bidirectional long short-term memory to detect retinal detachment using retinal fundus images automatically. In this paper, the best basis stationary wavelet packet transform is utilized for image analysis, modified VGG19-Bidirectional long short-term memory is employed as the deep feature extractors, and then obtained features are classified through the Adaptive boosting technique. The experimental outcomes demonstrate that our proposed method obtained 99.67% sensitivity, 95.95% specificity, 98.21% accuracy, 97.43% precision, 98.54% F1-score, and 0.9985 AUC. The model obtained the intended results on the presently accessible database, which may be enhanced further when additional RD images become accessible. The proposed approach aids ophthalmologists in identifying and easily treating RD patients.
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Affiliation(s)
- Sonal Yadav
- Bio-Medical Imaging Laboratory (BIOMIL), Department of Electronics and Communication Engineering, National Institute Of Technology Silchar, Assam-788010, India
| | - R Murugan
- Bio-Medical Imaging Laboratory (BIOMIL), Department of Electronics and Communication Engineering, National Institute Of Technology Silchar, Assam-788010, India.
| | - Tripti Goel
- Bio-Medical Imaging Laboratory (BIOMIL), Department of Electronics and Communication Engineering, National Institute Of Technology Silchar, Assam-788010, India
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Li S, Li M, Wu J, Li Y, Han J, Cao W, Zhou X. Development and validation of a routine blood parameters-based model for screening the occurrence of retinal detachment in high myopia in the context of PPPM. EPMA J 2023. [PMCID: PMC10015135 DOI: 10.1007/s13167-023-00319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Background/aims Timely detection and treatment of retinal detachment (RD) could effectively save vision and reduce the risk of progressing visual field defects. High myopia (HM) is known to be associated with an increased risk of RD. Evidently, it should be clearly discriminated the individuals with high or low risk of RD in patients with HM. By using multi-parametric analysis, risk assessment, and other techniques, it is crucial to create cutting-edge screening programs that may be utilized to improve population eye health and develop person-specific, cost-effective preventative, and targeted therapeutic measures. Therefore, we propose a novel, routine blood parameters-based prediction model as a screening program to help distinguish who should offer detailed ophthalmic examinations for RD diagnosis, prevent visual field defect progression, and provide personalized, serial monitoring in the context of predictive, preventive, and personalized medicine (PPPM/3 PM). Methods This population-based study included 20,870 subjects (HM = 19,284, HMRD = 1586) who underwent detailed routine blood tests and ophthalmic evaluations. HMRD cases and HM controls were matched using a nested case-control design. Then, the HMRD cases and HM controls were randomly assigned to the discovery cohort, validation cohort 1, and validation cohort 2 maintaining a 6:2:2 ratio, and other subjects were assigned to the HM validation cohort. Receiver operating characteristic curve analysis was performed to select feature indexes. Feature indexes were integrated into seven algorithm models, and an optimal model was selected based on the highest area under the curve (AUC) and accuracy. Results Six feature indexes were selected: lymphocyte, basophil, mean platelet volume, platelet distribution width, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Among the algorithm models, the algorithm of conditional probability (ACP) showed the best performance achieving an AUC of 0.79, a diagnostic accuracy of 0.72, a sensitivity of 0.71, and a specificity of 0.74 in the discovery cohort. A good performance of the ACP model was also observed in the validation cohort 1 (AUC = 0.81, accuracy = 0.72, sensitivity = 0.71, specificity = 0.73) and validation cohort 2 (AUC = 0.77, accuracy = 0.71, sensitivity = 0.70, specificity = 0.72). In addition, ACP model calibration was found to be good across three cohorts. In the HM validation cohort, the ACP model achieved a diagnostic accuracy of 0.81 for negative classification. Conclusion We have developed a routine blood parameters-based model with an ACP algorithm that could potentially be applied in the clinic with a PPPM approach for serial monitoring and predicting the occurrence of RD in HM and can facilitate the prevention of HM progression to RD. According to the current study, routine blood measures are essential in patient risk classification, predictive diagnosis, and targeted therapy. Therefore, for high-risk RD persons, novel screening programs and prompt treatment plans are essential to enhance individual outcomes and healthcare offered to the community with HM. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-023-00319-3.
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Affiliation(s)
- Shengjie Li
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Meiyan Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
| | - Jianing Wu
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yingzhu Li
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jianping Han
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenjun Cao
- Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital of Fudan University, Shanghai, China
- NHC Key Laboratory of Myopia, Shanghai, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
- Shanghai Engineering Research Center of Laser and Autostereoscopic 3D for Vision Care, Shanghai, China
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Mundae R, Haq Z, Adams OE, Parke DW, Tang PH. Evolving Trends for the Clinical Presentation of Primary Rhegmatogenous Retinal Detachments From Early to Late Phases of the COVID-19 Pandemic. Ophthalmic Surg Lasers Imaging Retina 2023; 54:78-83. [PMID: 36780637 DOI: 10.3928/23258160-20230117-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To evaluate the impact on trends in clinical presentation of acute, primary rhegmatogenous retinal detachments (RRD) from early to late phases of the COVID-19 pandemic. METHODS This study was a single-center, consecutive case series of 1,727 patients treated after vaccine availability ("late"; 3/29/21 to 9/26/21), corresponding time frame in previous year of pandemic ("early"; 3/30/20 to 9/27/20), and prior to pandemic ("pre"; 4/1/19 to 9/29/19). Primary outcome was proportion of patients presenting with macula-off RRD. Secondary outcomes included best-corrected visual acuity (BCVA) and primary proliferative vitreoretinopathy (PVR). RESULTS While macula-off RRD rates were significantly (P < 0.0001) elevated in early and late cohorts compared to the pre cohort, only the early cohort showed a significant (P < 0.0001) increase in both primary PVR presentation and complex RRD repair. Patients lost to follow-up in early cohort were significantly (P < 0.0001) higher than others. Early cohort showed significantly (P < 0.0001) worse final BCVA compared to others. CONCLUSION Patients in late pandemic were less likely to exhibit clinical features of worse RRD disease and have improved visual outcomes compared to those in early pandemic. [Ophthalmic Surg Lasers Imaging Retina 2023;54:78-83.].
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9
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Health literacy and ophthalmology: A scoping review. Surv Ophthalmol 2023; 68:78-103. [PMID: 35995252 DOI: 10.1016/j.survophthal.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 02/01/2023]
Abstract
As of 2020, it is estimated that 43.3 million people are blind, and an additional 553 million have mild to severe vision impairment.50 At least 1 billion worldwide have a vision impairment that could have been prevented or has yet to be addressed.54 Poor health literacy may be a significant contributor to the prevalence of eye disease. With implications on disease burden, progression, and health outcomes, a greater understanding of the role health literacy plays in ophthalmology is needed. This is the first scoping review to assess the impact of health literacy on eye health outcomes and blindness, including ocular screening rates and/or follow-up rates, treatment adherence, and self-care practices. PubMed, Embase, and CINAHL databases were searched systematically through November 12, 2021, and we evaluated the association between health literacy and ophthalmic outcomes in 4 domains: clinical outcomes, treatment adherence rates, screening and/or follow-up rates, and self-care practices. There is evidence to suggest that health literacy is associated with ophthalmic outcomes in all these domains. To better understand how health literacy impacts eye health, further longitudinal studies examining the effect of health literacy (using standardized health literacy measures) on ophthalmic outcomes are needed. We believe a specific ophthalmic health literacy survey could help achieve this goal and help target interventions to ultimately improve outcomes among ophthalmology patients.
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10
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Wharam JF, Wallace J, Argetsinger S, Zhang F, Lu CY, Stryjewski TP, Ross-Degnan D, Newhouse JP. Diabetes Microvascular Disease Diagnosis and Treatment After High-Deductible Health Plan Enrollment. Diabetes Care 2022; 45:1754-1761. [PMID: 34588211 PMCID: PMC9346988 DOI: 10.2337/dc21-0407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The Affordable Care Act mandates that primary preventive services have no out-of-pocket costs but does not exempt secondary prevention from out-of-pocket costs. Most commercially insured patients with diabetes have high-deductible health plans (HDHPs) that subject key microvascular disease-related services to high out-of-pocket costs. Brief treatment delays can significantly worsen microvascular disease outcomes. RESEARCH DESIGN AND METHODS This cohort study used a large national commercial (and Medicare Advantage) health insurance claims data set to examine matched groups before and after an insurance design change. The study group included 50,790 patients with diabetes who were continuously enrolled in low-deductible (≤$500) health plans during a baseline year, followed by up to 4 years in high-deductible (≥$1,000) plans after an employer-mandated switch. HDHPs had low out-of-pocket costs for nephropathy screening but not retinopathy screening. A matched control group included 335,178 patients with diabetes who were contemporaneously enrolled in low-deductible plans. Measures included time to first detected microvascular disease screening, severe microvascular disease diagnosis, vision loss diagnosis/treatment, and renal function loss diagnosis/treatment. RESULTS HDHP enrollment was associated with relative delays in retinopathy screening (0.7 months [95% CI 0.4, 1.0]), severe retinopathy diagnosis (2.9 months [0.5, 5.3]), and vision loss diagnosis/treatment (3.8 months [1.2, 6.3]). Nephropathy-associated measures did not change to a statistically significant degree among HDHP members relative to control subjects at follow-up. CONCLUSIONS People with diabetes in HDHPs experienced delayed retinopathy diagnosis and vision loss diagnosis/treatment of up to 3.8 months compared with low-deductible plan enrollees. Findings raise concerns about visual health among HDHP members and call attention to discrepancies in Affordable Care Act cost sharing exemptions.
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Affiliation(s)
- J Frank Wharam
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.,Department of Medicine, Duke-Margolis Center for Health Policy, Duke University, Durham, NC
| | | | - Stephanie Argetsinger
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Fang Zhang
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Christine Y Lu
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | | | - Dennis Ross-Degnan
- Division of Health Policy and Insurance Research, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Joseph P Newhouse
- Department of Health Care Policy, Harvard Medical School, Boston, MA.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA.,Harvard Kennedy School, Cambridge, MA.,National Bureau of Economic Research, Cambridge, MA
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11
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Gabriel M, Großpötzl M, Wallisch F, Djavid D, Pregartner G, Haas A, Wedrich A, Mayer‐Xanthaki C. In-depth analysis of risk factors for pseudophakic retinal detachments and retinal breaks. Acta Ophthalmol 2022; 100:e694-e700. [PMID: 34258879 PMCID: PMC9290023 DOI: 10.1111/aos.14974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
Purpose To provide a detailed analysis of risk factors for pseudophakic retinal detachments (PRD) and pseudophakic retinal breaks (PRB). Materials and methods We reviewed the medical records of cataract surgeries between 1996 and 2017 at a tertiary care hospital in Austria. A Cox proportional‐hazard regression model was used to analyse risk factors for PRD and PRB. Results Sixty‐five thousand six hundred and sixty‐two eyes (45 043 patients) underwent phacoemulsification, and 393 eyes (cumulative incidence 0.6%) were diagnosed with PRD (327 eyes) or PRB (66 eyes) during the follow‐up (median 7.1 years, range 0–21). Calculation of adjusted hazard ratios (HR) revealed a hierarchy of risk factors for either event including (from the highest to the lowest risk) posterior capsular rupture (PCR), patient age <65 years (compared with the age group >75 years), male gender and high myopia. Diabetes mellitus was associated with a lower risk. PCR was the strongest risk factor for PRD both in patients with and without perioperative vitrectomy (i.e. vitreous loss), but time to PRD was significantly reduced only following PCR with vitrectomy. Conclusions Posterior capsular rupture, young patient age, male gender and high myopia were risk factors for PRD, but diabetes mellitus was associated with a lower risk. PCR had the strongest association with PRD, regardless of the need for perioperative vitrectomy due to vitreous loss. Time to PRD was reduced in patients with PCR and vitrectomy compared with PCR without the need for vitrectomy or uneventful surgery.
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Affiliation(s)
| | - Manuel Großpötzl
- Department of Ophthalmology Medical University of Graz Graz Austria
| | - Fabian Wallisch
- Department of Ophthalmology Medical University of Graz Graz Austria
| | - Daniel Djavid
- Department of Ophthalmology Medical University of Graz Graz Austria
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation Medical University of Graz Graz Austria
| | - Anton Haas
- Department of Ophthalmology Medical University of Graz Graz Austria
| | - Andreas Wedrich
- Department of Ophthalmology Medical University of Graz Graz Austria
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12
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Mundae R, Velez A, Sodhi GS, Belin PJ, Kohler JM, Ryan EH, Tang PH. Trends in the Clinical Presentation of Primary Rhegmatogenous Retinal Detachments During the First Year of the COVID-19 Pandemic. Am J Ophthalmol 2022; 237:49-57. [PMID: 34801509 PMCID: PMC8603252 DOI: 10.1016/j.ajo.2021.11.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022]
Abstract
Purpose To evaluate the effect of 1 full year of the coronavirus disease 2019 (COVID-19) pandemic on clinical presentation of acute, primary rhegmatogenous retinal detachment (RRD). Design Single-center, retrospective observational cohort study. Methods Patients were divided into 2 cohorts: consecutive patients treated for primary RRD during the COVID-19 pandemic (March 9, 2020, to March 7, 2021; pandemic cohort) and patients treated during the corresponding time in previous year (March 11, 2019, to March 8, 2020; control cohort). Main outcome measures: Proportion of patients presenting with macula-involving (mac-off) or macula-sparring (mac-on) RRD. Results A total of 952 patients in the pandemic cohort and 872 patients in the control cohort were included. Demographic factors were similar. Compared with the control cohort, a significantly greater number of pandemic cohort patients presented with mac-off RRDs ([60.92%] pandemic, [48.17%] control, P = .0001) and primary proliferative vitreoretinopathy ([15.53%] pandemic, [6.9%] control, P = .0001). Pandemic cohort patients (10.81%) had significantly higher rates of lost to follow-up compared with the control cohort (4.43%; P = .0001). Patients new to our clinic demonstrated a significant increase in mac-off RRDs in the pandemic cohort (65.35%) compared with the control cohort (50.40%; P = .0001). Pandemic cohort patients showed worse median final best-corrected visual acuity (0.30 logarithm of the minimum angle of resolution) compared with the control cohort (0.18 logarithm of the minimum angle of resolution; P = .0001). Conclusions Patients with primary RRD during the first year of the COVID-19 pandemic were more likely to have mac-off disease, present with primary proliferative vitreoretinopathy, be lost to follow-up, and have worse final best-corrected visual acuity outcomes.
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13
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Ferreira A, Afonso M, Silva N, Meireles A. The impact of COVID-19 pandemic on surgical primary retinal detachments. Ophthalmologica 2021; 245:111-116. [PMID: 34673635 PMCID: PMC8678219 DOI: 10.1159/000520342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE To describe the impact of COVID-19 pandemic on the presentation characteristics, timings and surgical decisions for primary rhegmatogenous retinal detachment (RRD). METHODS Historical cohort including all patients who presented to the Surgical Retina Section at Centro Hospitalar Universitário do Porto (CHUPorto), over a 2-year period were recruited and divided in 2 groups: pre-COVID and COVID groups. The onset of the COVID-19 pandemic was recorded as starting on March 18, 2020, the same day the first pandemic-related lockdown came to effect in Portugal. RESULTS This study enrolled four hundred and forty-nine eyes of 443 patients: 272 in the pre-COVID group and 177 in the COVID one. Of the patients, 63.6% were male and the mean±SD age was 63.0±13.2y (range 13 to 92y). Of the eyes, 55.5% (n = 151) presented with macular detachment in the pre-COVID group compared with 66.9% (n = 119) in the COVID group (odds ratio [OR] 1.62; 95% confidence interval [CI], 1.09-3.86; p=0.016). The time from symptoms onset to hospital admission (p=0.021) and from admission to surgery (p<0.001) was longer in the COVID era. In the COVID period, silicone oil (OR 2.03, 95%CI 1.09-3.79, p=0.025) and C3F8 gas (OR 2.42, 95%CI 1.57-3.71, p<0.001) were used more often. No differences in anatomical success or final visual acuity were found. CONCLUSIONS The lockdown due to COVID pandemic affected the epidemiology of RRD. The services must adapt to the novel reality and produce backup plans for similar events. Despite the contingencies, the final results were not different between groups.
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Affiliation(s)
- André Ferreira
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal
- *André Ferreira,
| | - Miguel Afonso
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Nisa Silva
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Angelina Meireles
- Service of Ophthalmology, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Department of Ophthalmology, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, Porto, Portugal
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14
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The urgency of surgical treatment for rhegmatogenous retinal detachment. Ophthalmologe 2021; 118:160-165. [PMID: 33751188 DOI: 10.1007/s00347-021-01364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
The ideal timing of surgery in patients with rhegmatogenous retinal detachment has been discussed for decades. The study situation has improved in recent years so that recommendations can now be made. When the macula is detached, surgical treatment of the retinal detachment should be undertaken within a few days. When the macula is still attached, the near fovea and bullous superotemporal detachment should be classified as an emergency. When planning the operation environmental factors must also be considered, meaning that the performance of the intervention by an experienced surgical team is usually more important for the final result than the retinal condition alone. Influencing factors are discussed in this article and recommendations for dealing with these emergency patients are discussed.
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15
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Schranz M, Georgopoulos M, Sacu S, Reumueller A, Reiter GS, Mylonas G, Schmidt-Erfurth U, Pollreisz A. Incidence and surgical care of retinal detachment during the first SARS-CoV-2 lockdown period at a tertiary referral center in Austria. PLoS One 2021; 16:e0248010. [PMID: 33684142 PMCID: PMC7939259 DOI: 10.1371/journal.pone.0248010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/17/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To assess the influence of the SARS-CoV-2 lockdown in spring on frequency, severity and quality of care of rhegmatogeneous retinal detachments (RRD) in a tertiary referral center in Vienna, Austria. Methods Single center, consecutive case series with historical controls. Patients presenting with primary RRD during the first Austrian SARS-CoV-2 lockdown (March 16th–May 3rd 2020) and a corresponding control group consisting of the same time period of the preceding 3 years. Results The mean number of patients with RD in the reference group (RG) was 22 (± 1) and in the lockdown group (LG) 15. Median total delay, defined as onset of symptoms until surgery, in the RG was 5 (lower quartile: 3.0; upper quartile: 8.0) compared to 7 (3.0; 12.0) days in the LG, (p = 0.740). During the lockdown 67% of patients were referred from an external ophthalmologist compared to 52% in the RG, (p = 0.395). 34% of patients in the RG presented with an attached macula compared to 33% in the LG (p = 0.597). PVR was present in 49% of cases in the RG compared to 73% in the LG. Single surgery success (SSS) rates were lower in the LG (73.3%) compared to the RG (85.3%), (p = 0.275). Conclusion Patients with RRD during the SARS-CoV-2 lockdown presented and were treated within acceptable time limits, showed the same macula-on ratios but a higher PVR rate and a tendency towards worse SSS rates compared to the time period of the preceding 3 years.
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Affiliation(s)
- Markus Schranz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Michael Georgopoulos
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Stefan Sacu
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Adrian Reumueller
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Gregor S. Reiter
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
- OPTIMA, Christian Doppler Laboratory, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Georgios Mylonas
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Ursula Schmidt-Erfurth
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
- OPTIMA, Christian Doppler Laboratory, Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
| | - Andreas Pollreisz
- Department of Ophthalmology and Optometry, Medical University of Vienna, Vienna, Austria
- * E-mail:
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16
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Patel LG, Peck T, Starr MR, Ammar MJ, Khan MA, Yonekawa Y, Klufas MA, Regillo CD, Ho AC, Xu D. Clinical Presentation of Rhegmatogenous Retinal Detachment during the COVID-19 Pandemic: A Historical Cohort Study. Ophthalmology 2020; 128:686-692. [PMID: 33058938 PMCID: PMC7550253 DOI: 10.1016/j.ophtha.2020.10.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose To investigate the effect of the coronavirus disease 2019 (COVID-19) pandemic on the clinical presentation of acute, primary rhegmatogenous retinal detachment (RRD). Design Single-center, consecutive case series with historical controls. Participants Consecutive patients seeking treatment for primary RRD in a 50-day period during the COVID-19 pandemic (March 9–April 27, 2020) and the corresponding 50-day period during the previous year (March 4–April 22, 2019) in the United States. Methods The cohorts were compared to assess demographic variables and clinical presentations. Multivariate logistic regression was used to identify factors predictive of presenting macular attachment status. Main Outcome Measures The primary outcome was the proportion of patients with macula-on RRD at presentation. Secondary outcomes included visual acuity (VA), duration of symptoms before presentation, proportion seeking treatment within 1 day of symptom onset, and presence of primary proliferative vitreoretinopathy (PVR). Results Eighty-two patients were included in the 2020 cohort compared with 111 patients in the 2019 primary control cohort. Demographic factors were similar between the groups. Significantly fewer patients demonstrated macula-on RRD in the 2020 cohort (20/82 patients [24.4%]) than in the 2019 cohort (55/111 patients [49.5%]; P = 0.001). Patients in the 2020 cohort showed worse median VA at presentation (1.00 logarithm of the minimum angle of resolution [logMAR; Snellen equivalent, 20/200] in 2020 vs. 0.48 logMAR [Snellen equivalent, 20/60] in 2019; P = 0.008), fewer patients sought treatment within 1 day of symptoms (16/80 patients [19.5%] in 2020 vs. 41/106 patients [36.9%] in 2019; P = 0.005), and a greater proportion demonstrated primary PVR (11/82 patients [13.4%] in 2020 vs. 5/111 patients [4.5%] in 2019; P = 0.03). In multivariate analysis, younger age (P = 0.03) and established patient status (P = 0.02) were independent predictors of macula-on status in the 2020 cohort. Conclusions Patients with primary RRD during the 2020 COVID-19 pandemic were less likely to have macula-on disease and more likely to delay seeking treatment and to show worse vision and PVR.
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Affiliation(s)
- Luv G Patel
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Travis Peck
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Matthew R Starr
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Michael J Ammar
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - M Ali Khan
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Michael A Klufas
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Carl D Regillo
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Allen C Ho
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - David Xu
- Retina Service, Wills Eye Hospital, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania.
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17
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Jairath N, Commiskey P, Kaplan A, Paulus YM. FLASH: A Novel Tool to Identify Vision-Threating Eye Emergencies. INTERNATIONAL JOURNAL OF OPHTHALMIC RESEARCH 2020; 6:336-343. [PMID: 34141947 PMCID: PMC8208706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Two million patients visit emergency departments due to eye complaints annually in the United States, yet nearly one-quarter of these visits are for non-urgent ocular problems. Other patients often present a significant length of time after the onset of their symptoms, which may cause progression to irreversible vision loss. A major reason for this discrepancy is that many patients are unsure what symptoms constitute eye emergencies. The challenge is helping patients understand what constitutes a vision-threatening eye emergency, as well as the risks and complications that are associated with delaying their visit to the ophthalmologist or Emergency Department. OBJECTIVES To describe relevant literature on incidence, prevalence, presentation times, associated prognoses, risks, and complications of individual vision-threating eye emergencies, and present a novel acronym, FLASH (Floaters and flashes, Loss of vision, Aching pain, Second Image, Help), to better educate patients at risk for these conditions, fostering better symptom recognition and timely care. This manuscript is aimed at reaching public health departments, educational institutions, primary care offices and eye care centers as part of a dedicated patient education effort for vision-threatening eye emergencies. DESIGN / METHODS Narrative overview of the available literature on specific eye conditions presenting with the aforementioned symptoms, synthesizing findings retrieved from searches of computerized databases and authoritative texts. CONCLUSIONS In each condition presented in this article, symptom interval significantly impacts treatment prognoses. The cited literature demonstrates that patients often present late in emergent eye conditions resulting in vision loss.
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Affiliation(s)
- Neil Jairath
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Patrick Commiskey
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Ariane Kaplan
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
| | - Yannis M. Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
- Department of Biomedical Engineering, University of Michigan, 1000 Wall Street, Ann Arbor, MI 48105
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18
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Feltgen N, Callizo J, Hattenbach LO, Hoerauf H. Dringlichkeit der operativen Versorgung bei der rissbedingten Netzhautablösung. Ophthalmologe 2020; 117:858-865. [DOI: 10.1007/s00347-020-01191-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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19
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Ng H, La Heij EC, van Meurs JC. The duration of macular detachment in retinal detachment is difficult to determine. Acta Ophthalmol 2020; 98:e396-e397. [PMID: 31693277 DOI: 10.1111/aos.14294] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Heijan Ng
- Rotterdam Ophthalmic Institute Rotterdam The Netherlands
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20
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Li Z, Guo C, Nie D, Lin D, Zhu Y, Chen C, Wu X, Xu F, Jin C, Zhang X, Xiao H, Zhang K, Zhao L, Yan P, Lai W, Li J, Feng W, Li Y, Wei Ting DS, Lin H. Deep learning for detecting retinal detachment and discerning macular status using ultra-widefield fundus images. Commun Biol 2020; 3:15. [PMID: 31925315 PMCID: PMC6949241 DOI: 10.1038/s42003-019-0730-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/06/2019] [Indexed: 01/04/2023] Open
Abstract
Retinal detachment can lead to severe visual loss if not treated timely. The early diagnosis of retinal detachment can improve the rate of successful reattachment and the visual results, especially before macular involvement. Manual retinal detachment screening is time-consuming and labour-intensive, which is difficult for large-scale clinical applications. In this study, we developed a cascaded deep learning system based on the ultra-widefield fundus images for automated retinal detachment detection and macula-on/off retinal detachment discerning. The performance of this system is reliable and comparable to an experienced ophthalmologist. In addition, this system can automatically provide guidance to patients regarding appropriate preoperative posturing to reduce retinal detachment progression and the urgency of retinal detachment repair. The implementation of this system on a global scale may drastically reduce the extent of vision impairment resulting from retinal detachment by providing timely identification and referral. Li et al. develop a cascaded deep learning system for automated retinal detachment and macular status detection based on ultra-widefield fundus (UWF) images. With reliable and comparable performance to an experienced opthamologist, this system can also provide guidance to patients regarding appropriate preoperative posturing to reduce RD progression.
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Affiliation(s)
- Zhongwen Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Chong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Danyao Nie
- Shenzhen Eye Hospital, Shenzhen Key Laboratory of Ophthalmology, Affiliated Shenzhen Eye Hospital of Jinan University, Shenzhen, 518001, China
| | - Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China.,Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China.,Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, Florida, 33136, USA
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Fabao Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Chenjin Jin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Xiayin Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Hui Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Kai Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China.,School of Computer Science and Technology, Xidian University, Xi'an, 710071, China
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Pisong Yan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Weiyi Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Jianyin Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Weibo Feng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Yonghao Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China
| | - Daniel Shu Wei Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, 168751, Singapore, Singapore.,Duke-NUS Medical School, National University of Singapore, Singapore, 119077, Singapore
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou, 510060, China. .,Centre for Precision Medicine, Sun Yat-sen University, Guangzhou, 510060, China.
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21
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Jørgensen M, Savran MM, Christakopoulos C, Bek T, Grauslund J, Toft PB, Ziemssen F, Konge L, Sørensen TL, Subhi Y. Development and validation of a multiple-choice questionnaire-based theoretical test in direct ophthalmoscopy. Acta Ophthalmol 2019; 97:700-706. [PMID: 30816642 DOI: 10.1111/aos.14065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/02/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Direct ophthalmoscopy can reveal systemic, neurologic and ophthalmic conditions, but is poorly mastered among young physicians. A theoretical test is needed to measure effect of educational interventions. We developed and gathered validity evidence for a multiple-choice questionnaire (MCQ)-based theoretical test in direct ophthalmoscopy. METHODS The MCQ was developed by interviewing experts. Then, validity evidence was evaluated using Messick's validity framework. Content was ensured by inviting the experts to contribute in a Delphi-like process. Response process was ensured by piloting and by streamlining all instructions. Then, the test was taken by ophthalmologists and by medical students without experience in direct ophthalmoscopy. Results were used to evaluate internal structure (item quality analysis and internal consistency), relations to other variables (correlation of test scores to experience level) and consequences (establishment of pass-fail score and the consequences of its use). RESULTS The first phase of the study yielded 100 MCQs. In second phase, we identified that 60 items fulfilled predefined relevance and item quality requirements. These items demonstrated very high internal consistency (Cronbach's alpha = 0.95), significantly discriminated medical students from specialists (p < 0.001, independent samples t-test) and the established pass-fail score of 50 (83%) correct answers resulted in no false positives (students passing) and no false negatives (specialists failing). A Decision study identified that sampling 15 items suffice for certification. CONCLUSION We developed and validated an MCQ-based theoretical test in direct ophthalmoscopy that enables an evidence-based approach to measuring, evaluating and certifying the theoretical knowledge necessary for direct ophthalmoscopy.
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Affiliation(s)
- Morten Jørgensen
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Mona Meral Savran
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Department of Obstetrics and Gynaecology Copenhagen University Hospital Amager and Hvidovre Hvidovre Denmark
| | | | - Toke Bek
- Department of Ophthalmology Aarhus University Hospital Aarhus Denmark
| | - Jakob Grauslund
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research Faculty of Healthy Science University of Southern Denmark Odense Denmark
| | - Peter Bjerre Toft
- Department of Ophthalmology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Focke Ziemssen
- Center for Ophthalmology Eberhard‐Karl University Tübingen Tübingen Germany
| | - Lars Konge
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Torben Lykke Sørensen
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Yousif Subhi
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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22
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Demircan A, Alkın Z, Cakir I, Kesim C, Erdogan G. Comparison of pars plana vitrectomy for retinal detachment after failed pneumatic retinopexy and primary pars plana vitrectomy. J Fr Ophtalmol 2019; 42:146-152. [DOI: 10.1016/j.jfo.2018.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/03/2018] [Indexed: 11/28/2022]
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Peiretti E, Nasini F, Buschini E, Caminiti G, Lesnik Oberstein SY, Willig A, Bijl HM, Mura M. Optical coherence tomography evaluation of patients with macula-off retinal detachment after different postoperative posturing: a randomized pilot study. Acta Ophthalmol 2017; 95:e379-e384. [PMID: 28444950 DOI: 10.1111/aos.13397] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 01/02/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the presence of outer and inner retinal folds (RFs) and drop-out of the ellipsoid zone (EZ) occurring after surgical repair of macula-off rhegmatogenous retinal detachment (RRD) with different postoperative posture and preoperative use of adjuvant perfluorocarbon liquid (PFCO). METHODS In this prospective study, 56 eyes of 56 consecutive patients affected by RRD were subjected to 23- or 25-gauge pars plana vitrectomy (PPV). The patients were randomized in four groups (14 prone 5 hr without PFCO, 14 supine 5 hr without PFCO, 14 prone 5 hr with PFCO and 14 supine 5 hr with PFCO) and followed up with spectral domain optical coherence tomography (SD-OCT). RESULTS Spectral domain optical coherence tomography (SD-OCT) was recorded before surgery, at days 30 and 90 to detect the presence of outer RFs, inner RFs and drop-out of EZ and to follow their variation over time. No statistical significance was found in our groups for outer RFs, inner RFs, drop-out of EZ formation and evolution. The postoperative best-corrected visual acuity (BCVA) improved in all groups (mean preoperative BCVA 1.47 logMar ± 0.19, mean postoperative BCVA 0.27 logMar ± 0.11, p < 0.01), without statistical variations between the four groups in BCVA after surgery. CONCLUSION The use of adjuvant and variation in postoperative position did not change the risk of presenting outer RFs, inner RFs and drop-out of EZ after RRD.
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Affiliation(s)
| | - Francesco Nasini
- Department of Surgical, Medical, Molecular and Critical Area Pathology; University of Pisa; Pisa Italy
| | | | | | | | - Alissa Willig
- The Academic Medical Center Amsterdam; University of Amsterdam; Amsterdam The Netherlands
| | - Heico M. Bijl
- The Academic Medical Center Amsterdam; University of Amsterdam; Amsterdam The Netherlands
| | - Marco Mura
- The Academic Medical Center Amsterdam; University of Amsterdam; Amsterdam The Netherlands
- The Wilmer Eye Institute; Johns Hopkins University School of Medicine; Baltimore Maryland USA
- The King Khaled Eye Specialist Hospital; Riyadh Kingdom of Saudi Arabia
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Callizo J, Pfeiffer S, Lahme E, van Oterendorp C, Khattab M, Bemme S, Kulanga M, Hoerauf H, Feltgen N. Risk of progression in macula-on rhegmatogenous retinal detachment. Graefes Arch Clin Exp Ophthalmol 2017; 255:1559-1564. [PMID: 28551879 DOI: 10.1007/s00417-017-3696-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/04/2017] [Accepted: 05/09/2017] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To identify factors that may lead to a rapid progression in macula-on rhegmatogenous retinal detachment (RRD), in particular, those that may lead to macular involvement. METHODS Observational, prospective, single-center study. Patients referred for surgery due to primary rhegmatogenous retinal detachment with the macula on between 2009 and 2013 were included. Relevant factors analyzed included age, time delay until surgery, lens status, myopia, the detachment's location and configuration as well as number, size and type of retinal breaks. Eyes underwent optical coherence tomography to detect macular detachment. A multivariate analysis was performed to investigate the effect of several factors in the progression of retinal detachment. RESULTS A total of 116 eyes of 116 patients were included. Mean time delay between admission and surgery was 1.8 ± 1.4 days. Progression was observed in 19.8% of the eyes. Of those, 47.8% presented macular detachment. Ten of the 11 (90.9%) eyes presenting progression involving the macula also exhibited a bullous configuration, which was the only parameter that correlated significantly with detachment progression in patients with (p = 0.0036) and without (p = 0.0014) macular involvement. CONCLUSIONS For the first time in a prospective trial, a bullous configuration was found to be a highly significant predictor for progression in macula-on detachments. Our data support prompt surgery in patients diagnosed with bullous macula-on RRD.
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Affiliation(s)
- Josep Callizo
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany.
| | - Sebastian Pfeiffer
- Institute for Clinical Research GmbH, Georg-August University, Goettingen, Germany
| | - Eva Lahme
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Christian van Oterendorp
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Mohammed Khattab
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Sebastian Bemme
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Miroslav Kulanga
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Hans Hoerauf
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
| | - Nicolas Feltgen
- Department of Ophthalmology, Georg-August University, Robert-Koch- Str. 40, 37075, Goettingen, Germany
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