Electronic Health Records in Ophthalmology: Source and Method of Documentation.

PURPOSE: This study analyzed and quantified the sources of electronic health record (EHR) text documentation in ophthalmology progress notes. DESIGN: EHR documentation review and analysis. METHODS: Setting: a single academic ophthalmology department. STUDY POPULATION: a cohort study conducted between November 1, 2016, and December 31, 2018, using secondary EHR data and a follow-up manual review of a random samples. The cohort study included 123,274 progress notes documented by 42 attending providers. These notes were for patients with the 5 most common primary International Statistical Classification of Diseases and Related Health Problems, version 10, parent codes for each provider. For the manual review, 120 notes from 8 providers were randomly sampled. Main outcome measurements were characters or number of words in each note categorized by attribution source, author type, and time of creation. RESULTS: Imported text entries made up the majority of text in new and return patients, 2,978 characters (77%) and 3,612 characters (91%). Support staff members authored substantial portions of notes; 3,024 characters (68%) of new patient notes, 3,953 characters (83%) of return patient notes. Finally, providers completed large amounts of documentation after clinical visits: 135 words (35%) of new patient notes, 102 words (27%) of return patient notes. CONCLUSIONS: EHR documentation consists largely of imported text, is often authored by support staff, and is often written after the end of a visit. These findings raise questions about documentation accuracy and utility and may have implications for quality of care and patient-provider relationships.

Two single-piece acrylic intraocular lens choices and their effect on patient-reported driving habits.

PURPOSE: To determine whether intraocular lens (IOL) type affects patient driving habits 6 months to 5 years after cataract surgery, and to determine whether there were differences in self-reported driving habits between patients who received 1 of 2 IOLs. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Retrospective case series. METHODS: Patients completed a telephone-administered Driving Habits Questionnaire (DHQ) 6 months to 5 years after having bilateral cataract surgery with a single-piece hydrophobic acrylic IOL, SN60WF (Group 1) or ZCB00 IOL (Group 2), in both eyes. RESULTS: The study comprised 260 patients (130 in each IOL group). Of these, 117 in Group 1 and 114 in Group 2 were still active drivers. The DHQ response differences for each IOL group did not reach statistical significance, except for self-rated quality of driving and difficulties with driving at night. For these significant differences, contradictory results were found. CONCLUSIONS: Patients with either of the monofocal IOLs had similar self-reported driving habits after bilateral cataract surgery. The choice of IOL did not affect patients' postoperative driving habits.

Effect of intraocular lens glistening size on visual quality.

PURPOSE: To determine whether intraocular glistenings have an impact on light scatter and visual function. SETTING: John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN: Retrospective cohort study. METHODS: Pseudophakic patients with visual acuity no worse than 0.02 logMAR and no ocular pathology were enrolled. All had received a single-piece high-refractive-index acrylic intraocular lens (IOL). All IOLs were photographed, and glistenings were analyzed for size and density. Outcome measures included logMAR corrected distance visual acuity (CDVA), mesopic 10% contrast logMAR CDVA with and without glare, and straylight determination with a straylight meter (C Quant log). RESULTS: All 79 patients had glistenings within 2 diameter groups: 6 to 25 µm and over 25 µm. Linear regression for the nonstratified group was significant for IOL glistening size versus contrast visual acuity with glare. Linear regression for the 6 to 25 µm group was significant for a measure of severity index (%area) versus the straylight meter measurements, %area/size versus straylight meter measurements, IOL age versus CDVA, IOL age versus contrast visual acuity, and IOL age versus contrast visual acuity with glare. Linear regression for the over 25 µm group was significant for IOL age versus glistening size and %area/size versus contrast visual acuity, and density versus CDVA and contrast visual acuity with glare. CONCLUSIONS: Glistening %area, at a key size, correlated with random light scatter. The age of the IOL likely affects glistening size and visual parameters. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Effect of increased vacuum and aspiration rates on phacoemulsification efficiency.

PURPOSE: To evaluate the effect of vacuum and aspiration rates on phacoemulsification efficiency. SETTING: John A. Moran Eye Center Laboratories, University of Utah, Salt Lake City, Utah, USA. DESIGN: Experimental study. METHODS: Formalin-soaked porcine lenses were divided into 2.0 mm cubes, and 0.9 mm 30-degree beveled 20-degree bent tips were used with micropulse ultrasound (US) (6 milliseconds on and 6 milliseconds off) and a peristaltic flow system. Vacuum levels were tested at 200, 300, 400, and 500 mm Hg, and aspiration rates were tested at 20, 35, and 50 mL/min. Efficiency (time to lens removal) and chatter (number of lens fragment repulsions from the tip) were determined. RESULTS: Increasing vacuum increased efficiency only when going from 200 mm Hg to higher vacuum levels. Increasing aspiration increased efficiency at all points measured (25 mL/min versus 35 mL/min, P < .0001; 35 mL/min versus 50 mL/min, P = .012; 25 mL/min versus 50 mL/min, P < .0001). Chatter was highest at 200 mm Hg and decreased when vacuum was increased from 200 mm Hg to 300 mm Hg and up. Chatter decreased with increasing flow. CONCLUSIONS: Vacuum improved efficiency only up to 300 mm Hg and was more dependent on increasing flow. Similarly, chatter correlated with 200 mm Hg vacuum only and was more correlated with flow. Limitations of this study include use of only 1 US power modulation and hard nuclear material. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Optogenetics for retinal disorders.

Optogenetics is the use of genetic methods combined with optical technology to achieve gain or loss of function within neuronal circuits. The field of optogenetics has been rapidly expanding in efforts to restore visual function to blinding diseases such as retinitis pigmentosa (RP). Most work in the field includes a group of light-sensitive retinaldehyde-binding proteins known as opsins. Opsins couple photon absorption to molecular signaling chains that control cellular ion currents. Targeting of opsin genes to surviving retinal cells is fundamental to the success of optogenetic therapy. Viral delivery, primarily adeno-associated virus, using intravitreal injection for inner retinal cells and subretinal injection for outer retinal cells, has proven successful in many models. Challenges in bioengineering remain for optogenetics including relative insensitivity of opsins to physiologic light levels of stimulation and difficulty with viral delivery in primate models. However, targeting optogenetic therapy may present an even greater challenge. Neural and glial remodeling seen in advanced stages of RP result in reorganization of remaining neural retina, and optogenetic therapy may not yield functional results. Remodeling also poses a challenge to the selection of cellular targets, with bipolar, amacrine and ganglion cells all playing distinct physiologic roles, and affected by remodeling differently. Although optogenetics has drawn closer to clinical utility, advances in opsin engineering, therapeutic targeting and ultimately in molecular inhibition of remodeling will play critical roles in the continued clinical advancement of optogenetic therapy.