Establishing a Virtual Corneal Clinic: A Real-Time Teleophthalmology Approach.

PURPOSE: Keratoplasty patients require regular and timely follow-ups. During this COVID-19 pandemic which restricted global travel, we developed a novel real-time, hybrid teleophthalmology approach to comanage international keratoplasty patients between Singapore and Indonesia. METHODS: A retrospective consecutive observational study of 72 corneal patients (63 were postkeratoplasty) who attended a virtual corneal clinic (VCC) between June 2020 and April 2021 at JEC Eye Hospitals (JEC) in Jakarta, Indonesia. ZOOM Meeting software (Zoom Video Communication Inc, San Jose, CA) was used to simultaneously connect the Singapore corneal specialist at Eye & Cornea Surgeons (ECS), Singapore, using a real-time approach. Clinical examinations included full panels of video-linked corneal, glaucoma, and retinal imaging and investigations performed before real-time video-linked slit-lamp examination, with immediate clinical decision making between corneal specialists and patients. RESULTS: VCC enabled effective real-time clinical evaluation and collaborative clinical decisions, with full patient interaction, with the aim of maintenance of graft clarity, visual function, and management of comorbidities-a) topical and systemic medications were adjusted in 79.2% of patients; b) further referrals to glaucoma, retinal, and oculoplastic subspecialists were made in 16.6% of cases; c) additional adjunctive surgical procedures were performed at JEC in 6.9% cases; and d) government permission was obtained for 4 patients (5.6%) to fly to Singapore for urgent corneal surgery. CONCLUSIONS: The virtual corneal clinic is a novel real-time hybrid teleophthalmology approach which is effective in the comanagement of international keratoplasty patients and represents the advances in ophthalmic telemedicine.

Predictive value and applicability of ocular trauma scores and pediatric ocular trauma scores in pediatric globe injuries.

AIM: To evaluate the predictive value and applicability of Ocular Trauma Score (OTS) and Pediatric Ocular Trauma Score (POTS) for closed and open globe injuries in the pediatric group. METHODS: A retrospective study of closed and open globe injuries in children age of 0-18-year-old between 2012-2019 was conducted. Medical records were collected, and injuries were classified using Birmingham Eye Trauma Terminology System (BETTS). The predictive value and applicability of both OTS and POTS to final visual acuity (VA) were analyzed. RESULTS: Of 84 patients, 59 (70.2%) presented with closed globe injuries (CGI) and 25 (29.8%) with open globe injuries (OGI). The mean of initial VA was 0.832±0.904 logMAR. OTS and POTS was calculated. Initial VA (P<0.001) and traumatic cataract (P<0.001) were significantly associated with visual outcome, followed by organic/unclean wound (P=0.001), delay of surgery (P=0.001), iris prolapse (P=0.003), and globe rupture (P=0.008). A strong correlation between OTS and POTS and final VA (r=-0.798, P<0.001; r=-0.612, P<0.001) was found. OTS was more applicable in all age group of pediatric and in contrast to POTS, it was designed for 0-15 years old. POTS requires eleven parameters and OTS six parameters. Even though initial VA was not available, we could still calculate into POTS equation. CONCLUSION: OTS and POTS are highly predictive prognostic tools for final VA in CGI and OGI's in children.