Early Experience With Full-scope Shared-care Teleglaucoma in Canada.

PRCIS: Large Canadian full-scope, shared-care teleglaucoma facilitates efficient management and diversion of medically stable patients away from overburdened subspecialty clinics while allowing patients the convenience of shorter travel, shorter wait time, and continuity with one provider. This report shares Care1 protocol, early patient characteristics, and quality data. PURPOSE: This paper describes early experience with Care1, a large full-scope, shared-care teleglaucoma program. Optometrists located in high-demand locations saw patients in-person, acquired clinical history, performed a physical examination, organized diagnostic testing, then uploaded data to a proprietary online platform where they were able to collaborate with participating ophthalmologists to make plans for patient care. MATERIALS AND METHODS: The Care1 database was queried for all patients with a diagnosis of glaucoma or glaucoma suspect seen between February 2016 and March 2017. Clinical characteristics like diagnosis, ocular medication history, best-corrected visual acuity, intraocular pressure, cup-to-disc ratios, optical coherence tomography imaging results, and central corneal thickness were collected. Quality metrics studied included rates of referral to an in-person ophthalmologist and consistency of cup-to-disc assessments between in-person optometrists and remote ophthalmologists. RESULTS: A total of 4070 patients received care at a Care1 teleophthalmology site in 2 provinces for glaucoma assessment from February 2016 to March 2017. The population was 55.1% female, and the average age was 57.8 years. Overall, 97.3% of patients had a best-corrected visual acuity between 20/20 and 20/40 and 3.3% had an intraocular pressure >26. An in-person consultation with an ophthalmologist was recommended for 1.9% of patients. CONCLUSION: Early experience with this full-scope, shared-care teleglaucoma program in Canada indicates it is a convenient, collaborative model of care for glaucoma suspects, and medically stable glaucoma patients.

Pegging the porous orbital implant.

PURPOSE: Hydroxyapatite (HA) orbital implants are commonly used for the anophthalmic socket. With a HA implant, if motility is not satisfactory then a peg system can be surgically placed in attempts to improve motility. The authors report the technique and results of 83 patients who received motility peg placement over an 8-year period by a single surgeon. METHODS: Retrospective chart review of all patients with previous enucleation with either primary or secondary insertion of a HA implant who received a motility peg by a single oculoplastic surgeon between January 1999 and February 2007. RESULTS: Eighty-three patients underwent placement of a titanium peg and sleeve during the study period. Complications seen in the follow-up period included discharge, pyogenic granuloma, and others. Infection was experienced in 1 case. Fourteen patients (17%) required further surgical management due to complications. CONCLUSIONS: The largely positive results of this moderately sized case series validates the efficacy of pegging a hydroxyapatite orbital implant with minor risk of serious complications; this may have been due to a combination of factors including an experienced surgeon and adequate follow-up. As a procedure that can be completed in a hospital or minor surgical suite with sedation, it remains a viable option for many patients.

Ocular injuries associated with Airsoft guns: a case series.

BACKGROUND: As Airsoft guns have gained popularity in Canada, there have been an increasing number of associated ocular injuries. This study reviews and evaluates the ocular injuries and effects associated with trauma secondary to Airsoft guns. METHODS: The clinical records of 1232 patients seen by an on-call ophthalmology resident at the Royal Alexandra Hospital Eye Clinic were reviewed. Of these, 8 patients had ocular injuries involving an Airsoft gun. RESULTS: All 8 cases were monocular injuries in male patients with a mean age of 18 years. Documented injuries included hyphema, corneal contusion, subconjunctival hemorrhage, lid contusion, corneal abrasion, traumatic iritis, commotio retinae, and traumatic mydriasis. Presenting visual acuities ranged from 20/15 to light perception. INTERPRETATION: Injuries were confined mostly to the anterior segment and were not as serious as injuries reported from paintball and traditional BB gun injuries. However, hyphema was a commonly observed finding. Eye care professionals should be aware of the potential harm associated with injuries related to Airsoft guns.

Traumatic dislocation of the globe into the maxillary sinus.

CASE REPORT: We report a case of traumatic dislocation of the globe into the maxillary sinus following a bull-riding incident. COMMENTS: Traumatic dislocations of the eye into the sinuses are rare, and urgent management and surgical repair are indicated.

Giant cell arteritis in a neuro-ophthalmology clinic in Saskatoon, 1998-2003.

BACKGROUND: We present a retrospective review of all biopsy-positive cases of giant cell arteritis (GCA) presenting to a neuro-ophthalmology practice in Saskatoon, Saskatchewan. METHODS: Records of 141 consecutive patients who underwent temporal artery biopsy at the Saskatoon Eye Centre from July 1998 through June 2003 were reviewed. Patients that were biopsy-positive for GCA were studied and an estimated regional incidence was calculated. Study variables included age at diagnosis, sex, ethnicity, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level. RESULTS: Of 141 patients, 37 (26%) had a positive biopsy result for GCA; 11 underwent a second biopsy for a total of 152 biopsies. The average age of the biopsy-positive patients was 76.5 (SD 8.2) years, and the female-to-male ratio was 2.4:l. There were 35 patients (95%) of European descent and 2 patients (5%) of Aboriginal descent. Twenty-three patients had both ESR and CRP testing done before starting steroids. The ESR was elevated in 19 (83%) and the CRP in 22 (96%). The estimated incidence of GCA for Saskatoon and area was 9.4 per 100,000 for people over the age of 50 years. INTERPRETATION: GCA occurs primarily in people of European descent; however, it can affect North American people of Aboriginal descent. Sensitivity for the detection of GCA is higher in CRP than in ESR. The estimated incidence of GCA in Saskatoon and surrounding referral area is moderate compared with other northern areas.