Impact of social determinants of health on follow-up adherence, testing completion, and outcomes among pediatric glaucoma patients at a tertiary care center.

PURPOSE: To identify patient characteristics associated with visit attendance, treatment outcomes, and optical coherence tomography (OCT) testing in pediatric glaucoma patients at an urban tertiary care center. METHODS: The records of patients with childhood glaucoma seen from 2015 to 2021 were reviewed. Primary outcomes were the proportion of scheduled visits completed, visual acuity and intraocular pressure (IOP) at most recent follow-up, and rates of OCT testing. Social determinants of health evaluated included race and ethnicity, distance of residence from clinic, insurance carrier type and residence within Baltimore City County, the latter two serving as proxies for socioeconomic status. RESULTS: A total of 99 patients met inclusion criteria: 61% were male; 47%, White (non-Hispanic); 25%, Black (non-Hispanic); 11%, Hispanic/Latino; and 7% Asian/Pacific Islander. Mean distance from clinic was 45.3 miles. Mean visit completion rate was 90.4%; there was no statistically significant variation in visit completion rates by patient characteristics. IOP outcomes did not vary across patient groups, but visual acuity outcomes in affected eyes were significantly worse among Baltimore City County residents compared with non-residents. Only 22% of the cohort received ≥1 OCT per year, and patients living 0-29.9 miles from clinic had significantly lower odds of reaching the threshold than more distant patients. Patients with state-based insurance had significantly lower odds of being ≥50th percentile for rate of OCTs received compared to patients with commercial insurance. CONCLUSIONS: In children with glaucoma, residence within Baltimore City County was associated with significantly worse visual acuity outcomes, and close proximity to clinic was an independent predictor of lower rates of OCT testing, despite similar visit attendance rates and IOP outcomes across all groups.

A Survey to Identify Screen Test Usage by Certified Orthoptists Across the United States of America.

PURPOSE: To ascertain the use of screen tests for assessing strabismus under binocular viewing conditions by certified orthoptist colleagues around the United States of America. METHODS: A link to an online survey was distributed to all 440 registered members of the American Association of Certified Orthoptists in early 2022. A total of 135 certified orthoptists responded. RESULTS: Of the 135 respondents, 51% were from a public practice, 36% were private practice and 13% from a mixture of both. A large proportion of respondents did not use binocular screen tests to measure strabismus such as the Lancaster red/green test (85%) or Hess screen test (93%), although one respondent reported using the Harms screen test. Most respondents reported using single or double Maddox rods (75%), synoptophore (44%) and prisms (14%) in their practice to quantify strabismus clinically. CONCLUSION: There is limited use of screen tests in private and public practice in the USA. The ergonomic requirements of such tests are prohibitive to their implementation in modern clinical practice.

COVID-19 and its effect on the provision of ophthalmic care in the United Kingdom.

The first quarter of 2020 gave light to a novel virus, Coronavirus 2019 (COVID-19), causing a pandemic of unbridled proportions. The National Health Service in the United Kingdom issued guidance to ensure that capacity was increased in acute medical settings, to prepare for the surge of COVID-19 cases. The Royal College of Ophthalmologists followed suit with guidance on the curtailment of all elective activity, aimed at protecting both patients and staff. Ophthalmology is one of the busiest outpatient specialities, and risk stratification of patients with appointments cancelled or on review lists was paramount to ensure there was no serious, permanent harm to sight. Our way of working, as we knew it, had to change in a short period of time. Local emergency eye care was changed from a walk in service, with the implementation of a strict triage protocol. Ophthalmologists, as well as Otorhinolaryngology colleagues, were identified as being at high risk of infection, due to the close proximity of clinical examination. The redesign of clinical areas to allow for social distancing, slit lamp barriers and personal protective equipment was all implemented. This time of relative pause has provided the opportunity to harness new ways of working, including the streamlining of services, reduction of backlog and the incorporation of telemedicine. Health preparedness is a new lexicon to Ophthalmology departments across the world, and it will now have to be stringently implemented in the ophthalmic setting.

Endotheliitis-A Presentation of Acanthamoeba Keratitis.

PURPOSE: To report endotheliitis as an early, key presenting sign of Acanthamoeba keratitis in patients who are soft contact lens wearers. METHODS: We report 4 cases of patients presenting with pain, red eye, and reduction in vision in the context of soft contact lens wear. On examination, the predominant clinical finding was that of endotheliitis, localized fusiform stromal edema with corresponding keratic precipitates, anterior chamber inflammation, and minimal epithelial and anterior stromal signs. The classical signs of Acanthamoeba keratitis were not present. RESULTS: All 4 cases were clinically diagnosed as Acanthamoeba endotheliitis; corneal scrapes were negative; case 1 was polymerase chain reaction positive, and case 3 underwent confocal microscopy that showed double-walled cysts, suggesting Acanthamoeba. All responded well to anti-Acanthamoeba medication alone with 3 cases achieving complete resolution with minimal anterior stromal scarring by 7 weeks. Case 1 had steroid treatment before being seen at our unit and had a prolonged course of treatment with complete resolution by 4 months. CONCLUSIONS: It is imperative to have a high index of suspicion for Acanthamoeba in patients presenting with pain and endotheliitis in the context of contact lens wear, even in the absence of classical signs.