Predicting ophthalmic clinic non-attendance using machine learning: Development and validation of models using nationwide data.

BACKGROUND: Ophthalmic clinic non-attendance in New Zealand is associated with poorer health outcomes, marked inequities and costs NZD$30 million per annum. Initiatives to improve attendance typically involve expensive and ineffective brute-force strategies. The aim was to develop machine learning models to accurately predict ophthalmic clinic non-attendance. METHODS: This multicentre, retrospective observational study developed and validated predictive models of clinic non-attendance. Attendance data for 3.1 million appointments from all New Zealand government-funded ophthalmology clinics from 2009 to 2018 were aggregated for analysis. Repeated ten-fold cross validation was used to train and optimise XGBoost and logistic regression models on several demographic and clinic-related variables. Models developed using the entire training set were compared with those restricted to regional subsets of the data. RESULTS: In the testing data set from 2019, there were 407 574 appointments (median [range] age, 66 [0-105] years; 210 365 [51.6%] female) with a non-attendance rate of 5.7% (n = 23 309 missed appointments), XGBoost models trained on each region's data achieved the highest mean AUROC of 0.764 (SD 0.058) and mean AUPRC of 0.157 (SD 0.072). XGBoost performed better than logistic regression (mean AUROC = 0.756, p = 0.002). Training individual XGBoost models for each region led to better performance than training a single model on the complete nationwide dataset (mean AUROC = 0.754, p = 0.04). CONCLUSION: Machine learning algorithms can predict ophthalmic clinic non-attendance with relatively basic demographic and clinic data. These findings suggest further research examining implementation of such algorithms in scheduling systems or public health interventions may be useful.

Visual Outcomes of Patients With Peripheral Ulcerative Keratitis and the Effect of Immunosuppression-A 6-Year Experience in Queensland, Australia.

OBJECTIVE: Peripheral ulcerative keratitis (PUK) can cause significant ocular morbidity and mortality. This study aimed to review the effects of systemic immunosuppression on visual outcomes. METHODS: A state-wide, retrospective case series based in Queensland, Australia, was performed. A review of patients who presented with PUK to the major tertiary ophthalmology referral centers between January 2015 and January 2021 was undertaken. Parameters recorded included clinical features at presentation, investigations undertaken, treatment provided, visual outcomes, and mortality outcomes. The effect of immunomodulatory therapy on the change in vision from presentation to the most recent review was analyzed. RESULTS: Twenty-two eyes of 26 patients with PUK (average age 69.81±14.54 years) were included and had a mean follow-up period of 577.73 days. Twelve patients (54.5%) had systemic autoimmune disease, one patient (4.5%) had positive syphilis serology, and nine patients (40.9%) had idiopathic PUK. Eighteen patients (81.8%) were treated with systemic steroids and 10 patients (45.5%) were treated with steroid-sparing immunomodulatory therapy. Average logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) at presentation and final follow-up were 0.63±0.65 and 0.64±0.82, respectively. Those who were treated with immunomodulatory therapy had a nonstatistically significant improvement in BCVA (-0.10±0.29 with vs. +0.10±0.35 without), and a similar trend was seen for doxycycline (-0.08±0.09 with vs. +0.22±0.49 without). Four of five perforations (80%) were surgically managed. Four patients (18.2%) were deceased. CONCLUSIONS: Peripheral ulcerative keratitis poses significant clinical challenges and requires intensive medical treatment, frequently involving systemic immunomodulatory therapy. Surgical treatment is required in a significant minority of cases. Ocular management alongside the use of doxycycline and immunomodulatory therapy in consultation with specialist physicians can optimize visual and systemic outcomes.

Integration and remodelling of a collagen anterior lamellar keratoplasty graft in an animal model - A preliminary report.

There is an international shortage of donor corneas for transplantation to treat the 1.5-2.0 million new cases of blindness secondary to corneal disease. Research has therefore been directed towards the development of artificial corneas using alternative materials such as collagen. The biocompatibility of an acellular collagen-based scaffold for anterior lamellar keratoplasty was investigated in vivo in a rabbit model. This scaffold has previously shown promise as a corneal substitute in vitro. Slit-lamp and Optical Coherence Tomography examinations were carried out at 2 weeks, 1, 2, 3, and 6 months post-operatively. Graft-host integration was investigated using immunohistochemistry of the cornea at 6 months. Results showed that the graft was biocompatible, supported corneal re-epithelialisation, and showed no signs of rejection. Migration of stromal cells into areas of the graft was observed, however this was accompanied by extensive graft digestion. Whilst the scaffold was biocompatible, further modifications to the material or supplementation with matrix metalloproteinase inhibitors are required to bring us closer to a stable and fully integrated corneal substitute.

New Zealand adult ocular trauma study: A 10-year national review of 332 418 cases of ocular injury in adults aged 18 to 99 years.

IMPORTANCE: Ocular injury is a common, preventable cause of temporary and permanent disability. BACKGROUND: The current study evaluates the nationwide incidence, demographics and visual outcomes of adults with ocular injury in New Zealand. DESIGN: Nationwide retrospective review. PARTICIPANTS: New Zealanders aged 18-99 years from 2007 to 2016 with ocular injury requiring assessment by a registered medical practitioner. METHODS: New Zealand national and regional datasets were used to evaluate population-level statistics over a 10-year period. Visual and clinical outcome data were assessed using a random sample of 150 patients from a tertiary hospital. MAIN OUTCOME MEASURES: Annual incidence, aetiology, demographics, injury location, visual outcomes, protective eyewear use, surgical intervention and follow-up. RESULTS: A total of 332 418 adult eye injuries were recorded nationally. The annual incidence of eye injury was 1007/100 000 population/year. Patients were predominantly male (76.1%), of New Zealand-European ethnicity (74.6%) and aged between 20 and 29 years (21.1%). The most common mechanism of injury was "struck by object" (55.4%). Injuries occurred most commonly at home (48.4%), followed by commercial (15%) and industrial locations (13.8%). Injuries were more common in rural regions (P < .001). Protective eyewear use was reported in 6% of cases (n = 9, 95% confidence interval = 3.2-11.0). Most ocular injuries were managed exclusively in primary care (70.5%). CONCLUSIONS AND RELEVANCE: Adults with the highest risk of ocular injury are rural males aged 20 to 29 years. Protective eyewear use is uncommon in adults presenting with ocular injury and the majority of injuries are managed in primary care. Promotion of appropriate injury prevention strategies is an important public health message.

New Zealand childhood ocular trauma study: Analysis of 75 601 cases of ocular injury from 2007 to 2016.

IMPORTANCE: Childhood ocular injury is a common, preventable cause of potentially severe permanent disability. BACKGROUND: This study evaluates the nationwide incidence, demographics and visual outcomes of children with ocular injury in New Zealand. DESIGN: Nationwide retrospective review. PARTICIPANTS: All children in New Zealand aged 0 to 17 years from 2007 to 2016 with ocular injury requiring assessment by a medical practitioner. METHODS: New Zealand national and regional datasets were used to evaluate population-level statistics for ocular injury over a 10-year period. Visual and clinical outcome data were assessed using a randomized sample of 150 patients. MAIN OUTCOME MEASURES: Annual incidence, aetiology, demographics, injury location, visual outcomes, protective eyewear use, surgical intervention and follow-up. RESULTS: A national total of 75 601 cases were included with a mean incidence of 719/100 000 children/year. Cases were predominantly male (63.2%) and of New Zealand-European ethnicity (60.8%), aged 0 to 4 years (30.66%). Injury cause was most commonly "struck by object" (53.7%) and occurred in the home (50.9%). Tertiary hospital assessment and treatment was required in 17.7% where final visual acuity of 6/12 or worse was noted in 19.7% and protective eyewear use was reported in 2.7%. Maori and Pacific ethnicities were associated with higher rates of permanent visual impairment. CONCLUSIONS AND RELEVANCE: Children with the highest risk of ocular injury are males aged 0 to 4 years. Children of Maori or Pacific Island ethnicity and aged 15 to 17 years have the highest risk of ocular injury resulting in permanent visual impairment. Protective eyewear use is uncommon in children presenting with ocular injury. Promotion of appropriate injury prevention strategies is an important public health message.

Biomechanical changes in the cornea following cataract surgery: A prospective assessment with the Corneal Visualisation Scheimpflug Technology.

IMPORTANCE: Intraocular pressure (IOP) is often reduced following cataract surgery. Postoperative changes in corneal stiffness are likely to be at least partly responsible for any reduction in IOP measured with applanation tonometry. BACKGROUND: To determine the effect of cataract surgery and corneal incision size on corneal biomechanics. DESIGN: Prospective randomized trial. PARTICIPANTS: One hundred prospectively enrolled patients qualifying for cataract surgery. METHODS: Participants were randomized to clear corneal incisions with a 2.20 or 2.85 mm keratome. Corneal Visualisation Scheimpflug Technology (Corvis-ST) tonometry and dynamic corneal response measurements were obtained preoperatively, and 3 mo postoperatively. Multiple regression analysis was completed using R software. MAIN OUTCOME MEASURES: Corvis-ST biomechanical parameters. RESULTS: Ninety-three eyes of 93 patients were included in the final analysis. Mean Corvis-ST biomechanically corrected IOP decreased by 3.63 mmHg postoperatively (95% confidence interval = 2.97-4.35, P ≤ 0.01), and central pachymetry increased by 6.96 µm (4.33-9.59, P ≤ 0.01). Independent of IOP and pachymetry changes, mean (±SE) corneal first applanation stiffness parameter reduced by 9.761 ± 3.729 (P = 0.01) postoperatively. First applanation velocity increased by 0.007 ± 0.002 ms, second applanation velocity increased by 0.012 ± 0.004 ms (P ≤ 0.01), the first applanation deformation amplitude increased by 0.008 ± 0.002 mm (P ≤ 0.01) and the deflection amplitude at highest concavity increased by 0.030 ± 0.069 (P ≤ 0.01). There were no significant differences between different incision size groups. CONCLUSIONS AND RELEVANCE: Corneal stiffness is reduced 3 mo following cataract surgery and is associated with falsely low IOP measurements. This finding may be important for glaucoma patients and in particular when assessing the effectivity of minimally invasive glaucoma surgery devices.

Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes.

PURPOSE: To evaluate rotational stability and visual and refractive outcomes of supplementary toric IOLs (Sulcoflex Toric 653T, Rayner Intraocular Lenses Ltd) for residual astigmatic refractive error in pseudophakic eyes. METHODS: A retrospective interventional case series was conducted in a single surgeon practice. Charts of patients who had Sulcoflex Toric supplementary IOLs inserted between June 2009 and September 2015 were reviewed. Outcomes were compared between eyes with and without prior corneal transplant. Patients with at least 3-months follow-up were included. RESULTS: In 51 eyes, mean UDVA improved from 20/86 to 20/43 (p = 0.002), though UDVA was better in eyes without corneal grafts (20/31) than eyes with (20/62). The proportion of eyes achieving 20/20 UDVA was 43%, 61% and 17% overall, in eyes with prior graft and in eyes with no prior graft, respectively. Sixty-four percentage achieved a spherical equivalent of within 0.5D of target (84% no graft, 34% prior graft). Fifty-three percentage of eyes achieved a cylinder of within 0.5D of target (no graft: 73%, prior graft: 0%). Mean lens rotation was 8.23° on day 1, and mean maximal rotation during follow-up was 17.63°. Sixty-two percentage of IOLs required repositioning. Of those that required repositioning, this was conducted a mean of 2.3 times. The mean final IOL rotation (following repositioning if required) was 6.17°. CONCLUSION: Sulcoflex Toric supplementary IOLs result in good visual and refractive outcomes in eyes with no prior corneal graft. However, outcomes are sub-optimal in eyes with prior corneal transplantation, and the majority of lenses require repositioning.

Cicatricial ectropion surgery: a prospective study of long-term symptom control, patient satisfaction and anatomical success.

IMPORTANCE: Cicatricial ectropion repair is effective and has a low complication rate. BACKGROUND: To evaluate the effectiveness and long-term functional outcomes of surgical repair of lower lid cicatricial ectropion. DESIGN: Prospective consecutive case series. PARTICIPANTS: Forty-four consecutive operations for cicatricial ectropion repair. METHODS: Consecutive cases of cicatricial ectropion repair completed during 2007-2011 in Waikato Hospital and Hamilton Eye Clinic, New Zealand, were enrolled in the study following formal ethics approval. Ectropion repair was completed using inferior retractor repositioning, horizontal lid tightening and full-thickness skin grafting. MAIN OUTCOME MEASURES: Patient-reported symptoms and satisfaction, ectropion recurrence and punctal ectropion. RESULTS: Forty-four eyes of 40 patients (30 males and 10 female) were included in the study. The average age at surgery was 75 years. Watering and poor appearance were the most common presenting symptoms. Postoperative follow-up was 1-6 years (mean = 4 years). There were no major perioperative complications, one patient developed trichiasis postoperatively. There were five reoperations (11%) during the study period. Two patients underwent medial spindle procedures for symptomatic medial ectropion and three patients required additional horizontal lid tightening. Seventy percent of patients reported satisfaction with their long-term results despite the partial recurrence of symptoms in 45%. Ectropion recurrence in <1 year occurred in three patients. CONCLUSION AND RELEVANCE: In this series, satisfactory appearance and symptom control were reported by 68% of patients at long-term follow-up. Preoperative marked ectropion with marked lid laxity is associated with early treatment failure and may be regarded as a relative contraindication to surgical correction with this technique. Punctal ectropion is an unreliable indicator of functional success.

The rising tide of Acanthamoeba keratitis in Auckland, New Zealand: a 7-year review of presentation, diagnosis and outcomes (2009-2016).

IMPORTANCE: Acanthamoeba is an increasingly prevalent cause of vision-threatening microbial keratitis. BACKGROUND: To assess the incidence, clinical presentation, diagnosis and outcomes of patients with Acanthamoeba keratitis (AK) in Auckland, New Zealand over a 7-year period. DESIGN: Retrospective observational consecutive case series. PARTICIPANTS: Fifty-eight eyes of 52 patients diagnosed with AK. METHODS: All cases of AK were identified using a cross-referenced search of clinical, laboratory and pharmacy records from March 2009 to May 2016. MAIN OUTCOME MEASURES: Demographic and clinical data were collected including age, gender, risk factors, clinical manifestations, initial diagnosis, diagnostic investigations, treatment, presenting and final visual acuity and surgical interventions. RESULTS: Contact lens (CL) use was noted in 96% of unilateral and 100% of bilateral cases. The mean duration of symptoms at presentation was 21 days and the mean duration from presentation to definitive diagnosis was 14 days. Initial diagnosis was recorded as CL-related keratitis in 70.6%, viral keratitis in 15.5% and AK in 12.0%. The diagnosis was confirmed with In vivo confocal microscopy (IVCM) in 67.2%, corneal scrape in 22.4%, corneal biopsy in 1.7% and clinically in 8.6%. IVCM sensitivity was 83.0%. Surgical intervention was required in four patients, all with delayed diagnosis (range 63-125 days). The incidence of AK has more than doubled when compared with the preceding 7-year period. CONCLUSIONS AND RELEVANCE: AK is a rare vision-threatening protozoal infection with rapidly-increasing incidence in New Zealand, predominantly affecting CL users. Diagnosis is often challenging and when delayed is associated with worse outcomes. IVCM offers rapid diagnosis with high sensitivity.

Eyelid reconstruction using the "Hughes" tarsoconjunctival advancement flap: Long-term outcomes in 122 consecutive cases over a 13-year period.

This article evaluates the complications and long term functional and cosmetic outcomes of tarsoconjunctival advancement flaps for repairing a range of lower eyelid defects in a large cohort of consecutive cases. A retrospective series of 122 consecutive cases of eyelid reconstruction using tarsoconjunctival-advancement flaps was conducted at Waikato Hospital, or Hamilton Eye Clinic, New Zealand. All cases of lid reconstruction using tarsoconjunctival-advancement flaps between January 1, 2001 until April 3, 2014 were included for analysis. All patients provided written consent for surgery and the study complied with New Zealand Health and Disability Ethics Committee guidelines and the Declaration of Helsinki. Data were collected on patient demographics, lesion histology, defect size, adjuvant surgical procedures required for reconstruction, surgical and postoperative complications, cosmesis and patient satisfaction. Patients requiring lower eyelid reconstruction were predominantly male (56%) and basal cell carcinoma was the most common pathology (>80%). Male gender was associated with larger tarsoconjunctival-advancement-flap width (P-value = 0.0432), larger maximum flap width (20 vs 15 mm), and required on average more adjuvant procedures for reconstruction (1.80 vs 1.48, P-value = 0.02). Mean duration to flap division was 37 days and decreased over the duration of the study. Complicated cases were associated with shorter duration to flap division. Mean follow-up was 7 months, complications were observed in 14% with revision required in 4%. Tarsoconjunctival flap reconstruction of the lower lid is suitable for a range of defect sizes and produces excellent functional and cosmetic outcomes. Complications are relatively infrequent and may be associated in some cases with decreased duration to flap division.

Ophthalmic surgery in New Zealand: analysis of 410,099 surgical procedures and nationwide surgical intervention rates from 2009 to 2018.

BACKGROUND: Surgical intervention rates (SIR) provide a proxy measure of disease burden, surgical capacity, and the relative risk-benefit ratio of surgery. The current study assessed decade trends in ophthalmic surgery and calculated SIRs for all major classes of commonly performed ophthalmic procedures in New Zealand. METHODS: Retrospective population-based analysis of all ophthalmic surgical procedures performed in New Zealand from 2009 to 2018. National and regional datasets from public and private health sectors and industry were analysed. SIRs were calculated for all major ophthalmic procedures, and subgrouped by patient demographics. RESULTS: There were 410,099 ophthalmic surgical procedures completed with a 25.3% overall increase over 10 years. Procedures were mostly government-funded (51%, n = 210,830) with 71% of patients aged over 64 years. Cataract surgery (78%, n = 318,564) had the highest mean SIR (703/100,000/year) and increased by 25% during the study period, consistent with population growth in the over 64 years old age group. Vitrectomy surgery had the second highest mean SIR (67/100,000/year) and increased by 50%, well above national population growth during the study period. Other SIRs included conjunctival lesion-biopsy (38/100,000/year), glaucoma (33/100,000/year), strabismus (20/100,000/year), dacryocystorhinostomy (10/100,000/year), and keratoplasty surgery (4/100,000/year). CONCLUSIONS: This comprehensive review of New Zealand ophthalmic surgery reports increasing SIRs that cannot be explained by population growth alone. Cataract surgery numbers increased year on year consistent with the increase in the over 64 years old population. Vitrectomy surgery growth exceeded that of the national population, including those over 64 years.

Ocular surface squamous neoplasia in New Zealand: a ten-year review of incidence in the Waikato region.

BACKGROUND: Ocular surface squamous neoplasia (OSSN) is a relatively rare disease with a low mortality and highly variable incidence. Despite a high incidence of OSSN in the Southern hemisphere, there is limited epidemiological data for New Zealand. The current study aims to assess the incidence, demographics, and histological grade of OSSN in the Waikato region of New Zealand, home to ~10% of the population of New Zealand. METHODS: Non-interventional retrospective cohort study. All conjunctival biopsy histology reports from 2010 to 2019 in the Waikato region of New Zealand were analysed. Age, sex, and ethnicity were analysed and the incidence of OSSN was calculated. Main outcome measures included histological grade, rate of recurrence, and incidence of OSSN. RESULTS: A total of 386 patients underwent conjunctival biopsy with histology during the study period. Eighty-three lesions (22%) involving 80 patients (21%) were reported positive for OSSN. Patients with OSSN had a mean age of 68.9 years (SD = 13.2), were predominantly male (76%), and of New Zealand-European ethnicity (53%). Conjunctival intraepithelial neoplasia-1 (30%) was the most frequent diagnosis. Three patients (4%) had recurrent lesions requiring repeat biopsy. The peak annual OSSN incidence rate was 3.81/100,000 population in 2019. The overall ten-year incidence was 2.13/100,000 population/year. CONCLUSION: This is the largest study to investigate OSSN incidence in New Zealand. The incidence rate of OSSN is one of the highest rates reported in the literature.

Patient-reported quality of life and eligibility for cataract surgery: assessing the relationship between ethnicity and 'Impact on Life' questionnaire scores in New Zealand.

AIMS: The 'Impact on Life' (IoL) questionnaire is a patient reported quality-of-life assessment tool used to prioritise cataract surgery in New Zealand (NZ). This study evaluated the association between ethnicity and IoL questionnaire responses. METHODS: This is a retrospective cohort study of patients prioritised for public-funded cataract surgery between November 2014 and March 2019 in New Zealand. Data were extracted from the New Zealand Ministry of Health National Prioritisation Web Service database. Ethnic, demographic and IoL data for all patients who were prioritised for surgery were analysed after controlling for age, gender, visual acuity and cataract type. RESULTS: Of the 58,648 prioritisation events, over the four-and-a-half-year period, 46,352 prioritisation events had documented scores for the IoL questionnaire. The study population had a mean age of 74.4 years and had a female preponderance (74%). The average IoL score was 22.5/36 (SD 7.8). After controlling for age, gender, visual acuity (VA) and cataract type, there was only a marginal difference between Maori and non-Maori IoL scores (22.8/36 vs 22.4/36) despite statistical significance for the difference (p=0.001). Maori and Pacific people presented at a younger age (68.5 years and 66.7 years, respectively) with worse visual acuity than other ethnic groups (mean range 70.1-76.7 years). Mean IoL scores were 23.0/36 for Maori and Pacific people and 22.4/36 for other ethnic groups. CONCLUSIONS: Maori and Pacific people present younger with worse VA and more advanced cataracts at time of surgical prioritisation when compared with other ethnic groups. Despite these differences, after controlling for confounding factors, the mean IoL score did not differ to a level that was clinically significant between different ethnic groups in New Zealand at time of prioritisation for cataract surgery. These results suggest that there are no meaningful ethnic specific differences in patient reported quality of life for patients with cataract in New Zealand after controlling for other factors. Alternatively, the IoL tool may lack the sensitivity to detect meaningful ethnic disparities that may exist for quality of life in this cohort of patients.

Outcomes of a Toric Monofocal Piggyback Intraocular Lens for Residual Astigmatic Refractive Error in Pseudophakic Eyes.

PURPOSE/AIM: To evaluate the visual outcomes, refractive outcomes and rotational stability of a toric piggyback intraocular lens (1stQ AddOn, GmbH, Mannheim, Germany) for astigmatic refractive error in pseudophakic eyes. MATERIALS AND METHODS: Visual and refractive outcomes were assessed based on the standard graphs for reporting refractive surgery outcomes. Rotational stability was assessed according to the Intraocular Lens (IOL) standards of the International Organisation for Standards. RESULTS: Twenty-two eyes of 17 patients (age: 65.1 ± 9.3 years) underwent toric piggyback IOL insertion. After a minimum follow-up of 3 months, 18 eyes (82%) achieved an uncorrected distance visual acuity (UDVA) of 0.00 logMAR (20/20) or better and all eyes achieved 0.1 logMAR (20/25). Mean UDVA improved from 0.27 ± 0.03 to 0.12 ± 0.03 and 0.04 ± 0.04 at one and 3 months (all p < .05). Nineteen eyes (86%) achieved an UDVA at least equal to the pre-operative corrected distance visual acuity (CDVA). No eyes lost more than one line of CDVA. All eyes achieved within 0.5D of target spherical equivalent (SE). In 18 eyes (82%), the residual astigmatism magnitude was 0.5D or less. The mean absolute difference between the target axis and the achieved axis 1 and 3 months postoperatively was 2.5° ± 2.7° and 3.2° ± 3.3°, respectively. The final IOL orientation was within 10 degrees of target axis in 19 of 22 (86.4%) eyes, within 20 degrees in 21 of 22 (95.2%) eyes and within 30 degrees in 22 of 22 (100%) eyes. IOL rotational repositioning was required in two eyes (9.1%). CONCLUSIONS: In this cohort of patients, the 1stQ AddOn toric monofocal piggyback IOL resulted in very good visual and refractive outcomes and showed reasonable rotational stability. This IOL appears to be an effective treatment option for residual astigmatic refractive error in pseudophakic eyes.

Improving the provision of cataract surgery in New Zealand demands disruptive change.

Cataract surgery is a highly cost-effective treatment, but the surgical intervention rate in New Zealand ranks poorly compared with other high-income countries. The combination of a growing and ageing population, lost operating time due to the COVID-19 pandemic, and geographical disparities, is driving up an unmet demand for cataract surgery. We present several evidence-based strategies with overlapping benefits in access, equity, efficiency and sustainability. Key strategies include that Health New Zealand mandate a national prioritisation threshold for surgical access, and that PHARMAC leverage cheaper access to surgical supplies using nationally agreed equipment standards, establishing high-throughput cataract units, offering same day bilateral cataract surgery when appropriate, and rationalising post-operative care.

Agreement between 2 SS-OCT biometry devices.

PURPOSE: To assess the agreement between 2 swept-source optical coherence tomography biometry devices, Anterion and IOLMaster 700. SETTING: Tertiary referral center, Brisbane, Australia. DESIGN: Prospective comparative study. METHODS: Bland-Altman analysis was used to assess agreement between devices for flat (K1), steep (K2), and mean (Km) keratometry for anterior, posterior, and total cornea, lens thickness (LT), anterior chamber depth (ACD), central corneal thickness (CCT), white to white (WTW), and axial length (AL). Generalized estimating equations were used to control for within-patient between-eye correlations. Interdevice differences were considered clinically significant if they were likely to alter the spherical refractive outcome by 0.25 diopter (D) or more. RESULTS: 159 eyes of 91 patients (41 male, 50 female) were included. Statistically significant differences were found for K1, K2, and Km for anterior, posterior, and total cornea. When the Anterion was compared with the IOLMaster 700, the mean differences were as follows: anterior K1: -0.17 D, anterior K2: -0.18 D, anterior Km: -0.17 D, posterior K1: -0.38 D, posterior K2: -0.36 D, posterior Km: -0.37 D, total K1: -0.65 D, total K2: -0.82 D, and total Km: -0.74 D. The difference in posterior and total K metrics was clinically significant. Statistically significant differences were noted for LT: 0.159 mm, CCT: -0.004 mm, ACD: 0.054 mm, and WTW: -0.152 mm, although these were not found to be clinically significant. There was no significant difference between devices for AL. CONCLUSIONS: This study found statistically and clinically significant differences for both posterior and total keratometry between the Anterion and the IOLMaster 700. Posterior and total corneal parameters cannot be considered interchangeable between devices.

Agreement between a new swept-source ocular coherence tomography and a Placido disc-dual Scheimpflug ocular biometric devices.

PURPOSE: To evaluate the agreement between two biometry devices, the Heidelberg Anterion and the Galilei G6 Lens Professional. METHODS: Eyes were scanned with both biometry devices. Analysis of inter-device agreement was conducted for the following metrics: flat (K1), steep (K2) and mean K (Km) for anterior, posterior and total cornea, lens thickness (LT), central corneal thickness (CCT), anterior chamber depth (ACD), white to white (WTW) and axial length (AL). Generalised Estimating Equations were used to account for inter-eye correlation. Bland-Altman analysis was conducted to derive the mean difference (MD) and limits of agreement (LoA) between devices. Differences were deemed clinically significant if they would result in a change in post-operative refraction of 0.25D or more. RESULTS: 159 eyes of 91 patients were included. For the anterior cornea, no significant MD was found for K1 (-0.11D) and K2 (-0.10D), although a significant MD was found for Km (-0.10D). For posterior cornea, while there were no significant MDs between devices, the LoAs were wide for both posterior K1(-0.70, 0.68) and posterior K2 (-1.01, 1.29). For total corneal power, significant MDs were found in K1 (0.36D), and Km (0.26D) but not for K2 (0.17D). Significant MDs were found for LT (0.179mm), CCT (-0.005mm), ACD (-0.111mm) and WTW (-0.158mm), but not for AL (-0.021mm, p > 0.05).Conclusion: There are statistically but not clinically significant differences between Anterion and Galilei G6 Lens Professional in anterior Km, LT, CCT, ACD and WTW. Measurements of the posterior and total cornea are not interchangeable between devices.

Ocular Surface Squamous Neoplasia: A 12-Month Prospective Evaluation of Incidence in Waikato, New Zealand.

Ocular surface squamous neoplasia (OSSN) has a high incidence in the southern hemisphere. This prospective study evaluated the incidence of OSSN in the Waikato region of New Zealand. All patients presenting with pterygium or conjunctival lesions in the Waikato region in 2020 were included. All surgeons in the region were asked to send all conjunctival and corneal specimens excised for histopathologic examination. The primary outcome measure was the incidence of OSSN. Eighty-eight percent of all excised specimens were sent for histopathologic examination. Of the 185 excised lesions sent for histopathological assessment, 18 (10%) were reported as OSSN. Patients were on average 69.4 years of age (standard deviation, SD = 6.9), predominantly male (78%), and of New Zealand-European ethnicity (89%). The OSSN annual incidence was 3.67/100,000/year. Histology grades included conjunctival intraepithelial neoplasia (CIN)-I (25%), CIN-II (25%), CIN-III (12.5%), carcinoma in situ (25%), and invasive squamous cell carcinoma (SCC) (12.5%). One patient with invasive SCC required exenteration. This study identified a high incidence rate of OSSN and is the first prospective study to analyze OSSN epidemiology in New Zealand.