Predictors of Clinic Attendance After Community-Based Vision Screening.

Purpose: The purpose of this study was to analyze appointment attendance rates and patient characteristics associated with follow-up adherence after referral from a community vision screening event. Methods: A retrospective chart review of patients who attended a 2021 or 2022 community vision screening event and were referred to the university clinic for further care. Appointments were offered without charge and scheduled at the event. Associations between patients' clinical and demographic characteristics and appointment attendance were assessed by binary logistical regression. Results: A total of 935 patients attended the annual community vision screening events held in 2021 and 2022. Of these patients, 117 (13%) were referred to the clinic for follow-up, of whom 56 (48%) attended their scheduled follow-up appointment. The most common reasons for clinic referral included cataract (12, 10%), diabetic retinopathy (11, 9%), glaucoma (9, 8%), and challenging refractive error (9, 8%). Health insurance and male gender were predictors of follow-up (odds ratio [OR] = 3.08, 95% confidence interval [CI] = 1.19-7.99, P = 0.021 and OR = 2.72, 95% CI = 1.10-6.61, P = 0.035, respectively). Conclusions: Half of the referred patients followed up after vision screening. Providing appointment scheduling at the point of care and offering follow-up care at no cost may help to promote clinic follow-up, but further assessment of barriers to regular eye care is warranted. Health insurance most strongly predicted successful clinic attendance. Translational Relevance: This study emphasizes the enduring impact of health insurance status as a barrier to accessing comprehensive vision care.

Relentless placoid chorioretinitis: A review of four cases in pediatric and young adult patients with a discussion of therapeutic strategies.

Introduction: Relentless placoid chorioretinitis (RPC) is a rare, bilateral disease of the retinal pigment epithelium. The clinical course is prolonged and relapsing. No standard treatment has been established to date. The purpose of this case series is to report four cases of RPC in pediatric and young adult patients in which varying treatments were used, comparing them to previously published cases. Methods: A literature review was conducted to investigate currently published presentations and treatment options for RPC. A multicenter retrospective chart review was also performed on four consecutive patients. These patients were diagnosed with RPC because of new chorioretinitis lesions continuing to appear without or despite therapy for 5-36 months (2 patients), with a clinical course prolonged and relapsing, or because of the atypical location of the multiple lesions (>50) extending from the posterior pole to the equator and mid-peripheral retina (all four patients), which were not consistent with other entities like acute posterior multifocal placoid pigment epitheliopathy and serpiginous choroiditis. Results: All four cases of RPC received oral or IV steroids acutely, and three of these patients were transitioned to a steroid-sparing agent and biologic therapy: anti-TNF alpha or anti-IL-6. Quiescence of the chorioretinitis lesions was obtained after 7 months, 1 month, and 36 months; however, the latter had issues with treatment adherence. Mycophenolate mofetil was insufficient to control the disease in one patient, but tocilizumab and infliximab thereafter were effective after cessation of adalimumab due to side effects. Adalimumab when started the first month after the presentation was effective in controlling the disease in one patient. After the failure of interferon-alpha-2a, one patient displayed long-term control with infliximab. One patient did not require a steroid-sparing agent after oral prednisone taper as there was no evidence of progression or recurrence. Conclusion: This case series adds to the current knowledge regarding potential treatments for RPC, specifically the use of anti-TNF-alpha treatment and anti-IL-6 tocilizumab. In this case study, relapses of RPC were found among patients on mycophenolate mofetil and interferon-alpha-2a, and one case did not relapse on oral steroids without a steroid-sparing agent. Our findings suggest that adalimumab, infliximab, and tocilizumab may be useful medications to obtain quiescence of RPC.

Detection and Diagnosis of Retinoblastoma: Can Mobile Devices Be the Next Step Toward Early Intervention?

Retinoblastoma (RB) is a common intraocular cancer in pediatric patients worldwide, and screening is routinely performed throughout the first few years of life. The diagnosis is often made clinically; however, the diagnosis can be delayed due to undetectable leukocoria because of small tumor size at the time of examination, missed appointments, non-compliance with eye examinations, or failure to perform the exam. As mobile devices continue to gain in both popularity and functionality, their use via applications and smartphone attachments for ocular examination introduces a new avenue for screening, detection, and staging of RB both inside and outside the clinical setting. Currently, research regarding mobile device use is still in its infancy, and further research is required to determine whether mobile devices could play a significant role in assisting with the diagnosis of RB. The purpose of this systematic review was to determine whether the existing literature supports the use of mobile devices by healthcare providers, specifically ophthalmologists and non-ophthalmologists, as well as by parents for the early detection of RB. A comprehensive literature search was conducted via PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science with a total of 10 studies included in the final analysis.

Characteristics associated with barriers to eye care: A cross-sectional survey at a free vision screening event.

INTRODUCTION: Social determinants of health can limit access to regular eye care, but their role in ophthalmology is underexamined. The purpose of this study is to assess the relationship between patient characteristics and self-reported barriers to eye care. METHODS: This anonymous, cross-sectional survey was conducted at a two-day free eye clinic event in Pittsburgh, Pennsylvania. Adult patients presenting for vision screening were eligible to participate. Patient characteristics (demographics, health status) and self-reported barriers to eye care were collected. Predictors of barriers to eye care were analyzed using binary logistic regression. RESULTS: Of 269 eligible, consecutive patients approached for survey completion, 183 comprised the volunteer sample. The 183 participants (105 female patients [59%]) had a mean (standard deviation) age of 53 (15) years, and generally self-identified as Black (74, 46%) or White (67, 41%). While a third reported having no health insurance (60, 34%), the remaining two-thirds of participants had public (84, 48%) or private coverage (34, 19%). Three-quarters of respondents reported at least one barrier to receiving regular eye care (136, 76%), most commonly medical costs (89, 50%) and insurance issues (73, 41%). Not having health insurance or vision insurance was strongly associated with reporting at least one barrier to care (OR 5.00, p=0.002, and OR 7.46, p<0.001, respectively). Those with self-reported eye disease were more likely to report transportation difficulties (OR 4.45, p=0.013), and employed participants reported difficulty getting time off work to attend eye exams (OR 7.73, p=0.002). Finally, compared to Black race, White race was associated with a higher likelihood of reporting any barrier to care (OR 2.79, p=0.013). CONCLUSION: Three-quarters of vision screening attendees reported at least one barrier to regular eye care, most commonly medical costs and insurance.

Use of biologics for treatment of autoimmune inner ear disease.

OBJECTIVE: Biologic medications are novel therapeutics in the treatment of Autoimmune Inner Ear Disease (AIED), an etiology of Sensorineural Hearing Loss (SNHL). The goal of this study is to review the currently available literature on the efficacy of biologic medications on autoimmune-mediated hearing loss and associated symptomology among patients with AIED. METHODS: A systematic review of Pubmed, Scopus, Cochrane, and Web of Science databases was conducted to identify studies investigating the impact of biologic medications on hearing outcomes. Bias assessment was independently conducted by three authors and studies were stratified based on risk of bias. RESULTS: Of 174 unique abstracts screened, 12 articles met inclusion criteria for formal review. One randomized control trial, seven prospective cohort studies, and four retrospective cohort studies were included. Seven biologic medications, Etanercept, Infliximab, Adalimumab, Golimumab, Rituximab, Anakinra, and Canakinumab, were identified targeting three unique molecular targets, TNF-α, CD20, and IL-1. CONCLUSION: The effects of biologic medications in treating SNHL was highly variable without clear efficacy of a drug or drug category, likely due to rarity of disease, multifactorial etiologies of AIED, and cohort heterogeneity. However, several medications alleviate symptoms associated with AIED, such as vertigo and tinnitus. While biologic medications may be promising therapeutics in AIED patients, the evidence is currently inconclusive. Large-scale randomized control trials and prospective cohort reviews are required to establish the efficacy of biologic medications in treating hearing loss.

The use of mobile devices in oculoplastic and oral and maxillofacial surgery: A systematic review.

BACKGROUND: The use of smartphones in the United States has more than doubled since 2011. Mobile phone applications have versatile functions in ophthalmology, otolaryngology, and plastic surgery, such as increasing patient engagement in treatment, decreasing no-shows to appointments, and providing patient education. They also provide practical advantages to the clinician, including supplementing an otoscope, laryngoscope, or ophthalmoscope. Their use in oral and maxillofacial surgery (OMFS) and oculoplastic surgery has shown effectiveness for a variety of applications, such as for photography and medical reference. Research suggests that smartphones may improve clinical outcomes and efficiency. OBJECTIVE: The goal of this study is to provide a comprehensive and up-to-date systematic review of the available literature investigating mobile phone use in oculoplastic surgery and OMFS. METHODS: A query of terms relevant to oculoplastic surgery and OMFS was conducted using the databases PubMed, CINAHL, Web of Science, and PsychINFO to identify studies meeting inclusion criteria that investigated the implementation, efficacy, and outcomes of mobile device use in oculoplastic surgery and OMFS. A qualitative summary and discussion of the literature was subsequently synthesized. RESULTS: Out of a total of 289 articles reviewed, 171 were removed due to duplication across the four databases. Of the 118 studies remaining, 19 of them were included within the final qualitative review after screening the abstracts and full text for relevance. The articles were published between 2005 and 2020 from 7 different countries. Review of the relevant articles showed three settings in which mobile devices were used: communication between providers, communication between providers and patients, and as surgical supplementation. The literature review included use of mobile device photography for quality improvement, visual representation of procedures for patient education, and improved communication amongst providers and patients in the setting of oculoplastics and OMFS. CONCLUSION: Mobile device use has become ubiquitous across cultures worldwide. The literature suggests that mobile phone use in oculoplastic surgery and OMFS may improve clinical practice in multiple settings. However, further investigation is necessary to quantify the clinical benefits of mobile device use in oculoplastic and oral and maxillofacial surgery.

Ocular Manifestations in Patients with Sensorineural Hearing Loss.

Identification of ocular manifestations in patients with sensorineural hearing loss (SNHL) can have a large impact on the outcome and treatment of pediatric patients. Due to the common co-incidence of ocular manifestations and SNHL in children, both ophthalmologic and hearing loss screening and routine examinations must be conducted to minimize adverse outcomes and worsening of pathology. Early evaluation and diagnosis is imperative for intervention and further development of the patient. Co-incidence requires a thorough evaluation that includes a comprehensive history, examination, and diagnostic testing. In this article, a literature review was conducted to analyze the presentations of various diseases and syndromes, such as Alport Syndrome, Waardenburg Syndrome, Norrie Disease, Usher Disease, Stickler Syndrome, Marfan Syndrome, Congenital Rubella, and Hereditary Optic Neuropathies. We divided the various ocular pathologies into anterior and posterior segment presentations and associated systemic findings for better understanding. Additionally, this review aims to include an update on the management of patients with both ocular and hearing loss manifestations.

Clinical Features of Group A Streptococcus in Children With Pharyngitis: Carriers versus Acute Infection.

BACKGROUND: Among children with pharyngitis who test positive for group A Streptococcus (GAS), 10%-25% are GAS carriers. Current laboratory methods cannot distinguish acute infection from colonization. METHODS: We examined 2 separate longitudinal studies of children with symptomatic pharyngitis associated with a positive GAS throat culture (illness culture). In cohort 1, children presented with pharyngitis symptoms to a clinician, then had follow-up cultures at regular intervals. In cohort 2, throat cultures were performed at regular intervals and with pharyngitis symptoms. Illness cultures were categorized as acute infection or carrier based on follow-up culture results. In cohort 2, carriers were further categorized as a GAS carrier with a new emm-type or a GAS carrier with a previous emm-type based on typing data from prior culture results. For each cohort, symptoms were compared at the time of illness culture between carriers and those with acute infection. RESULTS: Cohort 1 (N = 75 illness cultures): 87% of the children were classified as acutely infected versus 13% carriers. Carriers were more likely to have upper respiratory (URI) symptoms [odds ratio (OR): 5.5; 95% confidence interval (CI): 1.4-22.1], headache (OR: 6.0; 95% CI: 1.2-40.5) or vomiting (OR: 5.5; 95% CI: 1.2-24.5). Cohort 2 (N = 122 illness cultures): 79% were acutely infected and 21% were carriers. Children determined to be carriers with a previous detected emm-type were more likely to have URI symptoms compared with those with acquisition of a new emm-type. CONCLUSIONS: Children with symptomatic pharyngitis and GAS on throat culture identified as carriers were more likely to present with URI and atypical symptoms than children who were acutely infected.