Prevalence of intraocular tumours detected by ultrasonography in eyes with opaque media

OBJECTIVE

To study the prevalence of intraocular tumours detected by screening ultrasonography in eyes with opaque media.

METHODS

Retrospective review of B-scan ultrasonography in eyes with opaque media and diagnosis of blindness or phthisis between January 1, 1994, and December 31, 2013. Ultrasounds for diagnostic purposes in acute endophthalmitis, retinal detachment, or vitreous hemorrhage were excluded.

RESULTS

There were 119 blind eyes with opaque media examined with B-scan ultrasonography. Mean patient age was 59 years, with visual acuity of hand motions or worse in 89 eyes (74.8%), elevated intraocular pressure in 23 eyes (19.3%), and pain in 30 eyes (25.4%). Follow-up was ≥1 year in 69 eyes (58%) with a mean 64 months (median, 56 months; range, 12-129 months). Of these 69 eyes, ultrasound frequency was more often than annual in 2 eyes (2.9%), annual in 2 eyes (2.9%), every 13-60 months in 43 eyes (62%), every 61-120 months in 19 eyes (27.5%), and less often than every 120 months in 3 eyes (4.3%). Sixteen eyes with opaque media only received ultrasound at presentation, and 6 eyes had screening ultrasonography only prior to evisceration or enucleation. No intraocular tumours were detected in any eye during the study period.

CONCLUSIONS

In this series, no intraocular tumours were detected by screening ultrasonography in eyes with opaque media. Larger studies with long-term follow-up are required to determine the utility and cost-effectiveness of serial ultrasonography monitoring. Ultrasound may have its highest utility in the setting of initial evaluation, clinical change, and preoperative work-up to avoid evisceration in the setting of occult malignancy.

Utility of large spot binocular indirect laser delivery for peripheral photocoagulation therapy in children

The purpose of this article is to demonstrate the utility of the large spot size (LSS) setting using a binocular laser indirect delivery system for peripheral ablation in children. One patient with bilateral retinopathy of prematurity received photocoagulation with standard spot size burns placed adjacently to LSS burns. Using a pixel analysis program called Image J on the Retcam picture, the areas of each retinal spot size were determined in units of pixels, giving a standard spot range of 805 to 1294 pixels and LSS range of 1699 to 2311 pixels. Additionally, fluence was calculated using theoretical retinal areas produced by each spot size: the standard spot setting was 462 mJ/mm2 and the LSS setting was 104 mJ/mm2. For eyes with retinopathy of prematurity, our study shows that LSS laser indirect delivery halves the number of spots required for treatment and reduces fluence by almost one-quarter, producing more uniform spots.

Automated processing of electronic medical records is a reliable method of determining aspirin use in populations at risk for cardiovascular events

BACKGROUND

Low-dose aspirin reduces cardiovascular risk; however, monitoring over-the-counter medication use relies on the time-consuming and costly manual review of medical records. Our objective is to validate natural language processing (NLP) of the electronic medical record (EMR) for extracting medication exposure and contraindication information.

METHODS

The text of EMRs for 499 patients with type 2 diabetes was searched using NLP for evidence of aspirin use and its contraindications. The results were compared to a standardised manual records review.

RESULTS

Of the 499 patients, 351 (70%) were using aspirin and 148 (30%) were not, according to manual review. NLP correctly identified 346 of the 351 aspirin-positive and 134 of the 148 aspirin-negative patients, indicating a sensitivity of 99% (95% CI 97-100) and specificity of 91% (95% CI 88-97). Of the 148 aspirin-negative patients, 66 (45%) had contraindications and 82 (55%) did not, according to manual review. NLP search for contraindications correctly identified 61 of the 66 patients with contraindications and 58 of the 82 patients without, yielding a sensitivity of 92% (95% CI 84-97) and a specificity of 71% (95% CI 60-80).

CONCLUSIONS

NLP of the EMR is accurate in ascertaining documented aspirin use and could potentially be used for epidemiological research as a source of cardiovascular risk factor information.