Time to fellow eye involvement in patients with unilateral diabetic macular oedema.

OBJECTIVE: To examine the time to onset of disease in the fellow eye of patients with unilateral DMO in routine clinical practice and to identify risk factors for development of bilateral DMO. DESIGN: Retrospective cohort study. PARTICIPANTS: One hundred forty treatment-naive patients 18 years or older with unilateral DMO presenting to Cole Eye Institute between January 2012 and July 2021. METHODS: Records of patients with unilateral DMO were reviewed for development of DMO in the fellow eye. Demographic, diabetic, ocular, and systemic characteristics were collected at initial DMO diagnosis date. Bivariate and multivariate analyses were performed and significant factors were modelled using Kaplan-Meier curves. RESULTS: Fifty patients with conversion to bilateral DMO and 90 patients without conversion were identified. Average time to bilateral DMO was 15.0 ± 15.7 months. 64% of patients converted within 1 year and 90% converted within 3 years. HbA1c (p = 0.003), diabetic retinopathy duration (p = 0.029), and diabetic foot disease (DFD) (p = 0.002) were identified as significant risk factors for conversion. Patients with better visual acuity at time of initial diagnosis and history of panretinal photocoagulation (PRP) (p = 0.044) or focal laser (p = 0.035) in the primary eye were also more likely to convert. CONCLUSIONS: Participants were most likely to develop fellow eye DMO within the first year after initial DMO diagnosis. In routine clinical practice, poor glycaemic control and DFD were risk factors associated with bilateral eye involvement. Clinicians may consider screening the fellow eye of high-risk individuals at each appointment within the first year of diagnosis.

Opioid Prescription in Ophthalmology and the Impact of a Decision Support Tool in Reducing Excess Dosing.

PURPOSE: To characterize opioid prescribing in ophthalmology and to determine the impact of an alert system on opioid prescription patterns. DESIGN: Retrospective pre- and post-implementation study. METHODS: The study population included individuals aged ≥18 years who received opioids written by ophthalmologists within a tertiary care center between January 3, 2015, and November 3, 2021, in the context of an opioid alert system. Mean morphine equivalent daily dose (MEDD) per prescription was compared before and after implementation of the opioid alert system. Additionally, mean MEDD per prescription was compared based on patient demographics and diagnoses. RESULTS: A total of 8014 individual patients were included in this study. The study population received a total of 9055 prescriptions, 77% of which were written for pain management related to an ophthalmic surgery. Mean MEDD per prescription decreased by 15.17 after implementation of the alert system (P < .001). A higher mean MEDD per prescription was observed among males (33.53 MEDD; P < .001). Black individuals received a higher mean MEDD per prescription (33.93 MEDD) compared with white individuals (32.80 MEDD; P = .03). Opioids written for disorders of the eyelid, lacrimal system, and orbit constituted 57.4% of total prescriptions. CONCLUSIONS: Prescription patterns based on patient demographics and diagnoses can provide foci for opioid prescription reform in ophthalmology. The observed decrease in opioid dosage may indicate realization of the alert system.