Pupil expansion device use and operative outcomes with topical dilation vs intracameral epinephrine in resident-performed cataract surgery.

PURPOSE: To compare the use of topical dilation drops vs topical drops with the addition of intracameral epinephrine in resident-performed cataract surgery and the effects on pupil expansion device (PED) use, surgical costs, and surgical times. SETTING: Iowa City Veterans Affairs Medical Center, Iowa City, Iowa, USA. DESIGN: Retrospective chart review. METHODS: Resident-performed primary cataract surgical cases using topical dilation drops only or drops with the addition of intracameral epinephrine were analyzed for PED use, surgical time, and costs in all patients and in patients with a history of tamsulosin use. RESULTS: In the topical group, PEDs were used in 31.1% of cases compared with 13.5% of cases in the intracameral group (P < .0001). History of tamsulosin use was noted in about one third of cases in both groups. For patients with a history of tamsulosin use, PED use decreased from 52.7% in the topical cases to 17.9% in the intracameral group (P < .0001). Surgical times were on average 7.1 minutes slower with PED use than without PED use. There was a medication savings of $50.44 USD per case in the intracameral group compared with the topical group. Factoring in the $100 to $130 USD per PED used, total surgical costs were $19 267 USD less in the intracameral group over 6 months. CONCLUSIONS: Intracameral epinephrine with lidocaine decreases the need for PED use during cataract surgery, lowers intraoperative costs, and improves efficiency compared with topical dilation drops alone.

Results of a pediatric vision screening program in western South Dakota.

BACKGROUND: South Dakota is one of eight states that do not require any vision screening for children. This study describes the results of the first children's vision screening program in the state. METHODS: Children ages 6 months to 12 years were screened using the SPOT photoscreener by lay volunteers as part of the Northern Plains Eye Foundation's Western South Dakota Children's Vision Screening Initiative (CVSI). Referral criteria were based on the recommendations of the manufacturer. Data was stratified by age group, sex, and percentage of children referred for hyperopia, myopia, astigmatism, anisocoria, anisometropia, and ocular misalignment. The cost benefit of amblyopia treatment in South Dakota was also calculated. RESULTS: Screenings were completed on 4,784 children from August 2012 to May 2014 with 62 excluded due to age. Mean age of the 4,722 (2,373 females) subjects was 6 years 7 months. Overall, the SPOT device referred 563 (11.9 percent) children. There was no significant difference in referral rate based on sex (p = 0.598). Children aged 73-144 months had the highest referral rate (12.2 percent) and children aged 12-30 months had the lowest referral rate (7.9 percent). The suspected reasons for referral based upon the screenings were as follows: 371 (7.9 percent) astigmatism, 24 (0.5 percent) ocular misalignment, 101 (2.1 percent) anisometropia, 135 (2.9 percent) myopia, 36 (0.8 percent) hyperopia, and 16 (0.3 percent) anisocoria. CONCLUSIONS: The SPOT photoscreener yielded an acceptable referral rate of 11.9 percent. This study represents an effective model for pediatric vision screening in South Dakota.