Patient Satisfaction with the Hybrid Telemedicine Model for Ophthalmology.

Background: The purpose of this research was to compare patient satisfaction between hybrid ophthalmology telemedicine and standard-of-care in-person visits. A retrospective, cross-sectional, case-control analysis of patient satisfaction based on survey data was used. Methods: Responses to the National Research Council Health Patient Survey were retrieved for randomly sampled hybrid ophthalmology telemedicine and in-person visits between March 11, 2020 and December 31, 2021 at a hospital-based eye clinic in Boston, Massachusetts. The primary outcome was based on the question "How likely would you be to recommend this provider to your family and friends?" (0-10 scale) with a score of 9 or 10 coded as satisfied. Two-sample t-tests, Pearson's chi-square tests, and bivariate logistic regressions were used to compare patient satisfaction scores between the hybrid and in-person cohorts. Demographic data, including age, sex, language, and self-reported race and ethnicity, were used as potential predictors of patient satisfaction in a multivariable logistic regression model. Results: There were 49 surveys from hybrid visits and 3,390 surveys from in-person visits. Hybrid visit patients reported high satisfaction scores without significant differences compared to in-person visit patients (hybrid 79% satisfied, in-person 82% satisfied, p = 0.728). Age was significantly associated with satisfaction in the hybrid cohort with the 65+ age group reporting lower satisfaction (below 65 years 100% satisfied, 65+ years 60% satisfied, p = 0.003). No association with age was observed in the in-person cohort. Conclusions: The hybrid ophthalmology telemedicine model can provide effective care without sacrificing patient satisfaction. Older patients may benefit from targeted interventions in future telemedicine models.

A case of accommodation-induced lens subluxation with iris displacement causing intermittent angle closure.

Purpose: To present an uncommon cause of intermittent angle closure in a young adult patient presenting with intermittent headache and blurry vision exacerbated by accommodation. Observations: A 37-year-old man reported experiencing intermittent blurry vision, headache, and pain in both eyes associated with prolonged periods of reading beginning at age 17. Serial intraocular pressure (IOP) measurements showed an increase in IOP from 14 to 32 mmHg in the right eye and from 9 to 37 mmHg in the left eye after 145 minutes of sustained accommodation while sitting up. IOP did not normalize after laser peripheral iridotomy but did normalize after clear lens extraction. Conclusions and importance: This case characterized a rare presentation of accommodation-induced IOP elevation in a young adult male that resolved only after clear lens extraction. The clinical takeaway was the importance of considering accommodation-associated angle closure in patients presenting with high intraocular pressures, eye strain, and/or headache with accommodative activities. Notable symptoms that should raise suspicion for this syndrome include halos, changes in visual acuity, and headache with accommodation. We suggested that patients presenting with these symptoms be followed closely, with a full glaucoma evaluation including gonioscopy and possible ultrasound biomicroscopy to assess for pediatric eversional angle closure with headache, plateau iris, angle closure glaucoma, and lens-induced angle closure.

Glaucoma medications.

Glaucoma is a common eye condition that affects millions of individuals worldwide, making it the second-leading cause of blindness. Because glaucoma is associated with increased IOP level, the primary goal in treatment of glaucoma includes lowering IOP to prevent further progression of the disease. While various surgical interventions exist, medical therapy is currently the first line of treatment. Medical treatment of glaucoma includes topical beta-blockers, alpha-2 agonists, prostaglandins, parasympathomimetics and CAIs. Anti-glaucoma agents help reduce IOP by affecting the production of aqueous humor or increasing the outflow of aqueous through the trabecular or uveoscleral pathway. Choosing an appropriate medical regimen can be challenging and various factors such as efficacy, safety, cost and patient compliance must be considered. First-line treatment is often topical beta-blockers or prostaglandin analogs. However, beta-blocking agents can be associated with systemic side effects and need to be used cautiously in patients with serious concomitant cardiopulmonary disease. Alpha-2 agonists and parasympathomimetics are often considered second- or third-line treatment options but good adjunctive agents. Oral CAIs are often indicated for patients with elevated IOP in an acute setting or for patients resistant to other glaucoma medications and patients who are not good surgical candidates.

Glaucoma and Systemic Disease.

Glaucoma is the leading cause of irreversible blindness in the world. Due to its potential to cause permanent vision loss, it is important to understand how systemic conditions and their respective treatments can be associated with or increase the risk for developing glaucoma. In this review, we examined the literature for up-to-date discussions and provided commentary on glaucoma, its pathophysiology, and associated risk factors. We discuss systemic diseases and the impact, risk, and mechanism for developing glaucoma, including pharmacologically induced glaucoma; inflammatory and auto-immune conditions; infectious, dermatologic, cardiovascular, pulmonary, renal, urologic, neurologic, psychiatric and systemic malignancies: intraocular tumors; as well as pediatric, and genetic conditions. The goal of our discussion of systemic conditions including their commonality, mechanisms, treatments, and associations with developing glaucoma is to emphasize the importance of ocular examinations and follow-up with the multidisciplinary teams involved in the care of each patient to prevent unnecessary vision-loss.

Macular Oxygen Saturation in Glaucoma Using Retinal Oximetry of Visible Light Optical Coherence Tomography.

Purpose: Oxygen saturation (sO2) plays a critical role in retinal pathophysiology, especially at the macula, which undergoes significant energy consumption. While macular damage has been suggested to be involved in early-stage glaucoma, there has been no report to date on non-invasive macular sO2 in glaucoma. Therefore, we conducted this study to compare macular sO2 associated with other clinical measurements between normal and glaucoma subjects and evaluate whether there are significant differences. Method: This is a cross-sectional study. We used visible light optical coherence tomography (VIS-OCT) for retinal oximetry in perifoveal vessels. The subjects from groups of normal, suspect/pre-perimetric glaucoma (GS/PPG) and perimetric glaucoma (PG) were scanned using VIS-OCT in the macular region with a sampling density of 512×256 in an area of 5×5 mm2. 48 eyes (16 normal, 17 GS/PPG and 15 PG) were included for the analysis. For each eye, we measured the sO2 of arterioles (AsO2), venules (VsO2), and calculated the difference between arterioles and venules (A-V sO2=AsO2-VsO2), oxygen extraction (OE=(AsO2-VsO2)/AsO2 ×100%). Additionally, we included Zeiss Cirrus OCT scans and 24-2 visual field test (VFT) for clinical benchmark. One-way ANOVA was used to compare the differences among the three groups. Spearman correlation tests were used for correlation sO2 markers to standard metrics including the thickness of ganglion cell layer and inner plexiform layer (GCL+IPL), circumpapillary retinal nerve fiber layer (cpRNFL) and mean deviation (MD) in VFT. Result: Significant differences were found among three groups for all VIS-OCT, Zeiss OCT, and VFT variables. Macular AsO2, A-V sO2, OE decreased, and VsO2 increased along with severity. Macular AsO2 and A-V sO2 were statistically correlated with GCL+IPL and cpRNFL in all eyes, as well as only PG eyes. Within PG eyes, the correlation between AsO2 and GCL+IPL is dominant in more damaged lower hemifield. Conclusion: The GS/PPG and PG subjects had significantly higher macular VsO2, lower A-V sO2 and OE indicating less oxygen consumption. The sO2 measured by retinal oximetry of VIS-OCT can be a potential metric for the early diagnosis of glaucoma.

Diverse Research Teams and Underrepresented Groups in Clinical Studies.

Importance: Several ophthalmic diseases disproportionately affect racial and ethnic minority patients, yet most clinical trials struggle to enroll cohorts that are demographically representative of disease burden; some barriers to recruitment include time and transportation, language and cultural differences, and fear and mistrust of research due to historical abuses. Incorporating diversity within the research team has been proposed as a method to increase trust and improve engagement among potential study participants. Objective: To examine how demographic factors of potential research participants and personnel may be associated with patient consent rates to participate in prospective ophthalmic clinical studies. Design, Setting, and Participants: This retrospective cohort study included patients from an urban, academic hospital who were approached for consent to participate in prospective ophthalmic clinical studies conducted between January 2015 and December 2021. Main Outcomes and Measures: Multivariable logistic regression assessing associations between patient and research personnel demographics and rates of affirmative consent to participate was used. Results: In total, 1380 patients (mean [SD] age, 58.6 [14.9] years; 50.3% male) who were approached for consent to participate in 10 prospective ophthalmic clinical studies were included. Of prospective patients, 566 (43.5%) were Black; 327 (25.1%), Hispanic or Latino; 373 (28.6%), White; 36 (2.8%), other race and ethnicity; and 78 (5.8%) declined to answer. Black patients (odds ratio [OR], 0.32; 95% CI, 0.24-0.44; P < .001) and Hispanic or Latino patients (OR, 0.31; 95% CI, 0.20-0.47; P < .001) were less likely to consent compared with White patients. Patients with lower socioeconomic status were less likely to consent than patients with higher socioeconomic status (OR, 0.43; 95% CI, 0.33-0.53; P < .001). Concordance between patient and research staff race and ethnicity was associated with increased odds of affirmative consent (OR, 2.72; 95% CI, 1.99-3.73; P < .001). Conclusions and Relevance: In this cohort study, patients from underrepresented racial and ethnic groups and those with lower socioeconomic status were less likely to participate in ophthalmic clinical studies. Concordance of race and ethnicity between patients and research staff was associated with improved participant enrollment. These findings underscore the importance of increasing diversity in clinical research teams to improve racial and ethnic representation in clinical studies.

Corneal Endothelial Cell Density in Normal Tension Glaucoma Compared to Healthy Controls.

The purpose of this study was to investigate corneal endothelial cell density (ECD) and morphology between normal tension glaucoma (NTG) and controls. A cross-sectional, single center study of 24 NTG and 26 age-matched healthy eyes were included. ECD, mean cell size (MCA) and coefficient of variance (CV) were analyzed, controlling for age and number and duration of concurrent glaucoma medications. NTG subjects had significantly lower ECD (2307 ± 514.7 vs. 2558 ± 278.5, p = 0.044) and larger MCA (458.3 ± 94.8 vs. 386.7 ± 57.3, p = 0.004), but no difference in CV compared to healthy subjects. NTG subjects stratified by number of glaucoma medications showed significant differences in ECD (p = 0.024) and MCA (p = 0.021), but no difference in CV. There were no significant differences in ECD, MCA or CV between subjects stratified by duration of glaucoma medication usage. After age-adjusting, there was no dose-dependent relationship between mean ECD or MCA and number of glaucoma medications. Post hoc analysis demonstrated only NTG subjects on three or more glaucoma medications had statistically significant differences in ECD (p = 0.032) and MCA (p = 0.037) compared to NTG subjects on two glaucoma medications. This study suggests that NTG is associated with lower corneal endothelial cell density and mean cell size.

A Baseline Study of Oxygen Saturation in Parafoveal Vessels Using Visible Light Optical Coherence Tomography.

The retinal macula is at the center of our visual field, and thus pathological damage in the macula significantly impacts an individual's quality of life. The parafoveal vessels form the inner retina provide oxygen perfusion, and the measurement of parafoveal oxygen saturation (sO2) can evaluate macular metabolism and provide pathophysiological insight. In this paper, for the first time, we present a baseline study of microvascular oxygen saturation (sO2) in perifoveal macular region using visible light optical coherence tomography (VIS-OCT) on normal eyes. The arterial and venous sO2 from all eyes was 92.1 ± 7.1 (vol %) and 48.4 ± 5.0 (vol %) (mean ± SD), respectively. Arteriovenous sO2 difference was 43.8 ± 9.5 (vol %). Marginal correlation was found between venous sO2 and intraocular pressure (IOP) among eyes. No significant correlation was found between sO2 and vessel topological features, including length, diameter, and distance to fovea. This baseline study could serve as a benchmark for the future sO2 investigation of retinal macular pathologies.

Partial Stenosis and Complete Punctal Closure Following Topical Netarsudil Use for Glaucoma.

PURPOSE: To describe patients who developed partial or complete punctal closure after the use of topical netarsudil in the treatment of glaucoma, with documented reversal of symptoms on drug cessation. PATIENTS AND METHODS: This is a retrospective, single-center case series including patients treated with topical netarsudil who were documented to have developed punctal disease ipsilateral to the eye(s) being treated. A literature review was also performed to identify other similar reports. RESULTS: A total of 10 patients were included in the study. Six patients developed partial punctal stenosis and 4 patients developed complete closure of the puncta in 1 or both eye(s) ipsilateral to the use of the topical medication. None of the patients developed punctal disease on the non-netarsudil side. The time from initiation of netarsudil to the documentation of punctal disease ranged from 5-32.2 months (18.41±9.94). In the patients with complete punctal closure, discontinuation of the topical medication led to clinical reappearance of the punctal opening, ranging from 31-83 days after drug cessation (45.75±21.57). In 8 cases, discontinuation of netarsudil resulted in improved epiphora and degree of punctal stenosis on clinical examination. CONCLUSIONS: The use of topical netarsudil for glaucoma may lead to punctal stenosis and complete punctal closure. These side effects of netarsudil are relevant to therapeutic considerations for glaucoma patients.

Systemic Barriers in Receiving Electronically Prescribed Glaucoma Medications.

PRCIS: Over a third of electronically prescribed glaucoma medications were not picked up within 1 month of patient request. Feedback-driven protocols may help minimize treatment interruptions attributed to electronic prescribing. PURPOSE: Glaucoma treatment relies on long-term medication compliance and many socioeconomic factors impact the ability of patients to receive their medications. This study aims to quantify treatment interruptions attributable to electronically prescribed medications and propose interventions to minimize this barrier. METHODS: This is a cross-sectional study of the electronic prescribing patterns at a tertiary care hospital serving a socioeconomically diverse patient population. Glaucoma medication refill requests received over a 6-week interval were reviewed and patient pharmacies were contacted 1 month after the request date to determine whether the medication was received by the patient. Patients who did not pick up the prescriptions were contacted and consented to participate in a survey to identify the barriers to acquiring the medications. RESULTS: Refill requests of 198 glaucoma medications met the inclusion criteria and the most common classes were prostaglandin analogs (44%) and alpha-2-agonists (21%). Medications were not obtained within 1 month in 71 (35.9%) cases. Prior authorization requirement was significantly associated with patients not obtaining their medication (odds ratio, 0.07; 95% confidence interval, 0.03-0.45). Patient reported challenges to successful receipt electronically prescribed medications included insurance coverage (32.2%) and pharmacy availability (22.6%). CONCLUSIONS: Approximately a third of electronically prescribed glaucoma medications were not received by patients within a month of refill request due to the need for prior authorization, insurance coverage, and pharmacy availability. A mechanism to alert providers and to address these barriers to medication access may minimize treatment interruption and disease progression.

Visible Light Optical Coherence Tomography of Peripapillary Retinal Nerve Fiber Layer Reflectivity in Glaucoma.

Purpose: To evaluate the clinical utility of visible light optical coherence tomography (VIS-OCT) and to test whether VIS-OCT reflectivity and spectroscopy of peripapillary retinal nerve fiber layer (pRNFL) are correlated with severity of glaucoma, compared with standard-of-care OCT thickness measurements. Methods: In total 54 eyes (20 normal, 17 suspect/preperimetric glaucoma [GS/PPG], 17 perimetric glaucoma [PG]) were successfully imaged with complete datasets. All the eyes were scanned by a custom-designed dual-channel device that simultaneously acquired VIS-OCT and near-infrared OCT (NIR-OCT) images. A 5 × 5 mm2 scan was taken of the pRNFL. The pRNFL reflectivity was calculated for both channels and the spectroscopic marker was quantified by pVN, defined as the ratio of VIS-OCT to NIR-OCT pRNFL reflectivity. The results were compared with ophthalmic examinations and Zeiss Cirrus OCT. Results: VIS-OCT pRNFL reflectivity significantly, sequentially decreased from normal to GS/PPG to PG, as did NIR-OCT pRNFL reflectivity. The pVN had the same decreasing trend among three groups. Normal and GS/PPG eyes were significantly different in VIS-OCT pRNFL reflectivity (P = 0.002) and pVN (P < 0.001), but were not in NIR-OCT pRNFL reflectivity (P = 0.14), circumpapillary RNFL thickness (P = 0.17), or macular ganglion cell layer and inner plexiform layer thickness (P = 0.07) in a mixed linear regression model. Conclusions: VIS-OCT pRNFL reflectivity and pVN better distinguished GS/PPG from normal eyes than Cirrus OCT thickness measurements. Translational Relevance: VIS-OCT pRNFL reflectivity and pVN could be useful metrics in the early detection of glaucoma upon further longitudinal validation.

Oral Sedation is Non-Inferior to Intravenous Sedation for Cornea and Glaucoma Surgery: A Randomized Controlled Trial.

Purpose: To determine whether oral sedation is as safe and effective as IV sedation for ophthalmic surgeries other than cataract surgery, we tested whether patient satisfaction with oral triazolam was non-inferior to IV midazolam for cornea and glaucoma surgeries. Patients and Methods: Seventy-five cornea and 49 glaucoma surgery patients 18 years and older at Boston Medical Center (Boston, MA) were randomized within each study group (cornea or glaucoma) to receive oral triazolam + IV placebo, or oral placebo + IV midazolam before surgery in a double-masked fashion. Supplemental IV anesthesia was administered as needed during surgery. The primary outcome measure was patient satisfaction with anesthesia, compared between oral and IV sedation groups via t-test for non-inferiority, based on 70 cornea and 43 glaucoma subjects completing the study. Secondary outcome measures included surgeon and anesthesia provider satisfaction with anesthesia, rate of supplemental IV anesthesia, and incidence of adverse events and surgical complications. Results: Using an a priori non-inferiority margin of 0.5, initial oral sedation was non-inferior to initial IV sedation in cornea (n=70, p<0.001) and glaucoma (n=43, p=0.017) groups, even after excluding subjects administered supplemental IV anesthesia. There were no significant differences in anesthesia provider or surgeon satisfaction, intra-operative complications, adverse events, or supplemental anesthesia between groups, except for higher anesthesia provider satisfaction with oral sedation in an Ahmed or Baerveldt implant ± cataract surgery sub-group (p=0.04). Subjects receiving supplemental anesthesia included 6 oral (18.2%) and 5 IV (13.5%) in the cornea group (p=0.59), and 7 oral (29.2%) and 6 IV (31.6%) in the glaucoma group (p=0.50). Conclusion: Our results suggest that an initial dose of oral triazolam is equivalent to IV midazolam for non-cataract anterior segment surgeries. However, there was a relatively high need for supplemental IV anesthesia during some surgery types, particularly with glaucoma tube shunt implantation.

Poor Correlation of Provider and Patient Satisfaction with Anesthesia in Ophthalmic Surgeries: A Secondary Analysis of a Clinical Trial.

Purpose: This secondary analysis of a clinical trial that measured surgeon, anesthesiologist, and patient satisfaction following ophthalmic surgery under monitored anesthesia care (MAC) with a benzodiazepine investigates the degree of association between patient satisfaction with anesthesia compared to surgeon and anesthesiologist satisfaction with anesthesia. Patients and Methods: Data from analogous 6-point surgeon satisfaction surveys and anesthesiologist satisfaction surveys were compared to data from a 6-point validated patient satisfaction survey collected from a clinical trial investigating satisfaction with different forms of benzodiazepine for patients undergoing cataract, retina, cornea, or glaucoma surgery. Relationships between measures were analyzed using Pearson's correlation coefficient, with further subgroup analysis based on language groups and single-question measures of satisfaction. Results: A total of 283 ophthalmic surgical cases were analyzed. Mean surgeon satisfaction was 5.27 (range, 1.33-6.00), mean anesthesiologist satisfaction was 5.12 (range, 1.17-6.00), and mean patient satisfaction was 5.28 (range, 2.58-6.00). The correlation between surgeon and patient satisfaction was 0.333 (p = 9.06e-9), while the correlation between anesthesiologist and patient satisfaction was 0.319 (p = 4.28e-8). There was no difference between English and non-English speaking patients in correlation between surgeon and patient satisfaction (p = 0.08) and anesthesiologist and patient satisfaction (p = 0.47). Conclusion: The data demonstrate a low level of association between patient satisfaction with anesthesia and provider satisfaction, even when patient language is taken into consideration. This suggests that providers are poor predictors of patient satisfaction with anesthesia and are unreliable judges of patient comfort perioperatively.

Practice preferences for glaucoma surgery: a survey of the american glaucoma society in 2008.

BACKGROUND AND OBJECTIVE: To evaluate glaucoma surgical practice patterns among members of the American Glaucoma Society (AGS). PATIENTS AND METHODS: An anonymous web-based survey was sent to AGS members to determine their preferred surgical approach in ten clinical settings. Survey results were compared with those from 1996 and 2002. RESULTS: A total of 125 (22%) AGS members responded to the survey. Mean glaucoma drainage device (GDD) usage increased from 17.5% (range: 5% to 37%; standard deviation [SD]: 10.9%) in 1996 to 50.8% (range: 15% to 76%; SD: 17.3%) in 2008, and mean trabeculectomy usage decreased from 80.8% (range: 62% to 93%; SD: 11.3%) in 1996 to 45.5% (range: 16% to 80%; SD: 17.9) in 2008. GDD was most popular in none of 8 clinical settings in 1996, and 5 of 8 clinical settings in 2008. Mitomycin C was selected as an adjunctive antifibrotic agent to trabeculectomy in 85% to 99% of cases. CONCLUSION: Glaucoma surgical practice patterns have changed since 1996. The use of a GDD has progressively increased, and the popularity of trabeculectomy decreased between 1996 and 2008. Mitomycin C remains the most frequently selected antifibrotic agent used as an adjunct to trabeculectomy.From Boston Medical Center (MAD), Boston University School of Medicine, Boston, Massachusetts; Bascom Palmer Eye Institute (SJG, WJF, WS, RKP), University of Miami, Miller School of Medicine, Miami, Florida; and the Department of Ophthalmology (PPC), University of Washington, Seattle, Washington.The authors have no financial or proprietary interest in the materials presented herein.Address correspondence to Steven J. Gedde, MD, Bascom Palmer Eye Institute, 900 NW 17th Street, Miami, FL 33136. E-mail: sgedde@med.miami.edu Received: January 19, 2011 Accepted: March 09, 2011.

Real-World Clinical Impact of Netarsudil 0.02% at an Urban Safety-Net Hospital.

Purpose: To analyze the efficacy, safety, and accessibility of netarsudil 0.02% in patients with glaucoma (suspect, open or closed) at a safety-net academic medical center, Boston Medical Center (BMC). Methods: Retrospective chart review of patients prescribed netarsudil 0.02% for uncontrolled glaucoma at BMC between December 2017 and September 2019. Outcome measures included change in intraocular pressure (IOP) from baseline and evaluation of adverse events (AEs). Results: One hundred thirty patients (60% severe stage) were analyzed. The IOP reduction from baseline was about 3 mmHg. Fifty-four patients (42%) experienced an AE (eg, conjunctival hyperemia). Thirty-eight patients (29%) started netarsudil 0.02% in lieu of laser or surgery. Ninety-nine patients (71%) required prior authorization for insurance coverage of netarsudil 0.02%. Ten patients (7%) were unable to obtain netarsudil 0.02% due to issues with insurance coverage. Conclusion: Netarsudil 0.02% yielded significant IOP reduction in our cohort, however, to a smaller degree compared with prior studies that bore equivocal IOP reduction regardless of baseline IOP. Conjunctival hyperemia was the most common AE. In a limited number of patients, netarsudil 0.02% was not covered by insurance.

Global Health Curricula in Ophthalmology Residency Programs in the United States.

Objective The aim of the study is to investigate the design, content, and administration of global health curricula within ophthalmology residency programs in the United States (U.S.) and share the curriculum utilized in the Department of Ophthalmology at Boston University School of Medicine (BUSM). Design A survey designed through the Association of University Professors in Ophthalmology platform was emailed to residency program directors at 106 accredited ophthalmology residency programs. Setting BUSM Department of Ophthalmology, Boston, MA. Tertiary clinical care. Participants Twenty-eight ophthalmology residency program directors responded, which represent 26% of the total number of residency programs in the United States. Twenty-seven programs fully completed the survey, and one program partially completed the survey. Results Of the respondents, three programs do not include global health curricula. The most common curricular elements included are: lectures ( n = 15, 60%); wet laboratories ( n = 10, 40%); and journal clubs ( n = 9, 36%). In terms of annual frequency, global health activities occur: twice a year ( n = 12, 46%); less than once a year ( n = 10, 39%); or every few months ( n = 4, 15%). Fewer than half of programs ( n = 10, 42%) incorporate local outreach at least once a year into their program. Twelve programs (48%) do not incorporate ethics-related topics, while the 13 remaining programs (52%) incorporate them at least once annually. The most common curricular topic is surgical techniques, with manual small incision cataract surgery (MSICS) being the most frequently emphasized ( n = 17, 68%). Conclusion A robust global health curricula combined with a hands-on international component can contribute to a well-rounded training experience. Many ophthalmology residency programs value the importance of incorporating global health into their residents' training. The most common elements of global health curricula in U.S. ophthalmology residency programs included are teaching of surgical techniques for resource-limited settings and international electives. Further investigation into the impact of different components of a global health curriculum on both resident experience and international partnerships is warranted.

A Comparison of Patient Acceptance of 3 Eye Drop Instillation Aids.

PRECIS: Patients can be quite amenable to using eye drop instillation aids. We should consider recommending these devices to patients who otherwise struggle with drop instillation and medication adherence. PURPOSE: The purpose of this study was to compare patient acceptance of 3 commercially available eye drop instillation aids in a diverse tertiary care population. METHODS: In this prospective, randomized controlled study, 39 patients being treated with topical antihypertensives were assigned to Arm A (no intervention) or Arm B (AutoDrop, AutoSqueeze, or SimplyTouch). Subjects in Arm B were instructed to administer their eye drop with the assigned drop aid at every use for ~6 weeks. Satisfaction surveys were administered at 3 and 6 weeks, where patients also reported the number of drops missed. RESULTS: Thirty-two of 39 subjects completed study participation and full data analysis. Within this total group, 24 subjects were randomized to drop aids (AutoDrop N=10, AutoSqueeze N=8, SimplyTouch N=6), and 8 were randomized to no drop aid. At the 3 and 6-week timepoints, patients found instillation easier with AutoDrop (70.0%, 60.0%) followed by the AutoSqueeze (62.5%, 75.0%), and lastly SimplyTouch (33.3%, 33.3%). For the AutoSqueeze, the mean number of drops missed with and without the drop aid were significantly different (P=0.015 at 3 wk, P=0.008 at 6 wk). There was no difference in the mean number of drops missed with the AutoDrop and SimplyTouch at either timepoint. CONCLUSIONS: For the AutoDrop and AutoSqueeze groups, over 60% of the patients found the devices helpful and would consider using them long-term. Our results suggest that patients would be amenable to using eye drop instillation aids, although more objective data is needed to determine whether these devices would improve medication compliance and clinical outcomes.

Visible light optical coherence tomography angiography (vis-OCTA) facilitates local microvascular oximetry in the human retina.

We report herein the first visible light optical coherence tomography angiography (vis-OCTA) for human retinal imaging. Compared to the existing vis-OCT systems, we devised a spectrometer with a narrower bandwidth to increase the spectral power density for OCTA imaging, while retaining the major spectral contrast in the blood. We achieved a 100 kHz A-line rate, the fastest acquisition speed reported so far for human retinal vis-OCT. We rigorously optimized the imaging protocol such that a single acquisition took < 6 seconds with a field of view (FOV) of 3×7.8 mm2. The angiography enables accurate localization of microvasculature down to the capillary level and thus enables oximetry at vessels < 100 µm in diameter. We demonstrated microvascular hemoglobin oxygen saturation (sO2) at the feeding and draining vessels at the perifoveal region. The longitudinal repeatability was assessed by < 5% coefficient of variation (CV). The unique capabilities of our vis-OCTA system may allow studies on the role of microvascular oxygen in various retinal pathologies.

Combined Endocyclophotocoagulation and Phacoemulsification in Patients with Glaucoma of African Descent.

The aim of this study was to evaluate the outcomes of combined endocyclophotocoagulation (ECP) and phacoemulsification regarding vision, refraction, intraocular pressure (IOP), medication dependence, and complications in patients of African descent. A retrospective chart review was performed including all cases of ECP combined with phacoemulsification from October 2015 to March 2017. Exclusion criteria consisted of patients who were not of African descent and patients with <1 month follow-up. IOP was the primary outcome. Thirty-two eyes of 29 patients were included in the study. Mean ± standard deviation (SD) of IOP decreased from 17.30 ± 6.30 mmHg preoperatively to 15.88 ± 4.23 mmHg at the last postoperative visit (P = 0.301). In 2 of eight patients who did not demonstrate a difference in pre- and postoperative IOP changes, all IOP lowering medications were stopped. The mean ± SD of follow-up was 5.05 ± 4.08 months with a range of 1 to 18 months. The mean ± SD number of medications used for each patient for IOP control decreased from 2.59 ± 1.01 preoperatively to 1.97 ±1.38 (P = 0.045). Average visual acuity improved from 20/50 preoperatively to 20/25 (P = 0.002). Postoperative complication rate was low. ECP combined with phacoemulsification was effective to decrease IOP lowering medication dependence in patients of African descent. We found that combined ECP and phacoemulsification can lead to a significantly decreased dependence on IOP lowering drops, with some patients demonstrating complete independence from drops following surgery. Although there was not a significant decrease in IOP postoperatively when analyzed collectively, larger studies might to find such an association. Combined ECP and phacoemulsification has been shown to be a safe combination in patients with refractive glaucoma and may be considered if a patient desire less dependence on IOP lowering drops once other first-line methods have failed, or as a bridge between conservative and more definitive surgical treatment.

Longitudinal detection of retinal alterations by visible and near-infrared optical coherence tomography in a dexamethasone-induced ocular hypertension mouse model.

The retina, as part of the central nervous system, has distinct anatomical and structural properties for its visual function. Light scattering spectroscopy, while widely used for tissue structural characterization and disease diagnosis, has been relatively unexplored in the living retina. Recently, we have developed a fiber-based visible and near-infrared optical coherence tomography system (vnOCT) for in vivo retinal imaging, to uniquely measure a spectroscopic marker (VN ratio) sensitive to nanoscale pathological changes. In the present study, we applied vnOCT in an animal model of glaucoma (dexamethasone-induced ocular hypertension mouse) and tested the capabilities of four optical markers, VN ratio, peripapillary retinal nerve fiber layer (RNFL) thickness, total retinal blood flow, and hemoglobin oxygen saturation ( sO 2 ), for the detection of retinal ganglion cell (RGC) damage in association with ocular hypertension. We found that RNFL-RGC VN ratio and arteriovenous (A-V) sO 2 are capable of detecting early retinal alteration in ocular hypertensive eyes, preceding measurable change of RNFL thickness. This study suggests a potential clinical application of vnOCT in early detection of glaucoma.