Mismatch of corneal specialists' expectations and keratoconus knowledge in general ophthalmologists - a prospective observational study in Switzerland.

BACKGROUND: To assess whether Swiss general ophthalmologists have the minimal keratoconus knowledge that corneal specialists would expect them to have. METHODS: Corneal specialists defined "minimal keratoconus knowledge" (MKK) with respect to definition, risk factors, symptoms and possible treatment options of keratoconus. A telephone interview survey was conducted among one hundred ophthalmologists (mean age 51.9 years (SD 9.5), 60 % male) from the German-speaking part of Switzerland. For each participant, years of work experience, number of keratoconus patients seen per year and access to a topography device were obtained. We calculated the proportion of MKK and examined in multivariate analyses whether ophthalmologists with access to topography and with greater work experience performed better than other groups. RESULTS: No single ophthalmologist had MKK. The mean MKK was 52.0 %, and the range was 28.6-81.0 %. Per 10 years of working in private practice, the MKK decreased by 8.1 % points (95 % CI: -14.2, -2.00; p = 0.01). Only 24 % of participants correctly recalled the definition of keratoconus, 9 % all risk factors, 5 % all symptoms and 20 % all treatment modalities. The MKK values were not associated with the number of keratoconus patients seen per year and the availability of topography to diagnose keratoconus. CONCLUSIONS: There is a substantial mismatch between corneal specialist' expectations and general ophthalmologists' knowledge about keratoconus. The low recall of symptoms and risk factors may explain why ophthalmologists diagnose relatively few cases of keratoconus, resulting in inefficient care delivery and delayed intervention.

Agreement of intraocular lens power calculation between 2 SS-OCT-based biometers.

PURPOSE: To assess agreement of measurements by 2 swept-source optical coherence tomography biometers and to evaluate the prediction error (PE) in intraocular lens power calculation with 7 formulas. SETTING: Tertiary public eye hospital. DESIGN: Consecutive observational. METHODS: Axial length (AL), keratometry (K), anterior chamber depth (ACD), lens thickness (LT), and corneal diameter (CD) were measured with the IOLMaster 700 (Biometer A) and Anterion (Biometer B). Agreement was quantified by the limits of agreement and concordance correlation coefficient (CCC). The PE, the median absolute error, and the mean absolute error of the Barrett Universal II, EVO 2.0, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T formulas were investigated after constant optimization. RESULTS: In 78 eyes from 78 patients, excellent agreement was obtained for AL (CCC >0.99), very good agreement for K, ACD, and LT (CCC >0.95), and strong agreement for CD (CCC >0.72). An additive offset of 0.07 mm was measured for ACD and LT whose mean values were higher with Biometer B (P < .001). No statistically significant difference was found between the PEs and their absolute values when comparing the results of each formula between the 2 biometers. CONCLUSIONS: Agreement of biometric measurements by the 2 biometers was high, although Biometer B provided higher mean values of ACD and LT by 0.07 mm. In cataract patients with normal eye length, measurements by the 2 biometers did not lead to different refractive outcomes with the 7 formulas investigated.

Don't be afraid of the dark - OCT angiography through a black intraocular lens.

PURPOSE: To report a case in which optical coherence tomography (OCT) and OCT angiography (OCT-A) allowed imaging of the posterior pole in a patient fitted with a black occlusive intraocular lens (IOL). OBSERVATIONS: Following retinal central artery occlusion, a 52-year-old patient suffered from disturbing residual light perception. Occlusive contact lenses blocked the light insufficiently, so that the patient had to rely on an eye patch for relief of symptoms. After no neovascularization had formed during an observation period of 12 months, a black IOL (Morcher 85F) was implanted, blocking wavelengths in the visible spectrum but allowing transmission in the near-infrared spectrum. Slit lamp photography, OCT and OCT-A were performed pre- and postoperatively. Postoperatively, slit lamp photography could no longer provide images of the posterior pole, proving the effective blockade of wavelengths in the visible light spectrum. In contrast, transmission in the near-infrared spectrum allowed for OCT and OCT-A imaging of the fundus. The complete suppression of the disturbing perception of light succeeded only temporarily. CONCLUSIONS AND IMPORTANCE: The implantation of a black IOL does not prevent the imaging of the retinal microvasculature by OCT-A. Black IOLs can therefore be considered even if continued monitoring of the vascular situation of the posterior pole is required.