Assessment of Direct Costs of Admission Due to Presumed Microbial Keratitis in a Tertiary Referral Hospital in Thailand: A 7-Year Retrospective Study.

Objective: To evaluate the direct healthcare cost of admission and examine the effects of cost drivers of treating presumed microbial keratitis (MK) at a tertiary referral hospital. Design: Retrospective study. Methods: A total of 741 patients who presented with MK were included. All information regarding costs was collected, and demographic data were employed for risk factor analysis. Results: The total cost of treating MK over a 7-year period at Rajavithi Hospital was US$14,514,625.04, while the median cost was US$10,840.17 per patient (Q1-3, US$5866.56-24,172.28). The medical professional services were the highest cost category in terms of both total cost of treatment over 7 years and median cost per patient, accounting for US$6,474,718.43 and US$5235.20 (Q1-3, US$2582.79-10,474.24) respectively. In 2020, the total cost of treatment declined, corresponding with fewer hospitalized patients; however, the median cost per patient was the highest of all years, amounting to US$15,089.90 (Q1-3, US$8064.17-29102.50), while the median cost per patient from 2014 to 2019 was US$9969.96 (Q1-3, US$5177.98-21,942.68). Statistical significance was found in the median cost per patient in 2020 compared to the median cost per patient in 2014-2019 (p-value 0.019). Risk factors associated with the more expensive cost of treatment were longer length of stay (LOS); age more than 60 years old; readmission; diabetes mellitus (DM); hypertension; and heart disease. Conclusion: There were several key factors impacting the direct healthcare costs of severe MK treatment. Medical professional services emerged as the most substantial cost category, while longer hospital stays, older age groups, readmission cases, and comorbidities such as diabetes mellitus, hypertension, and heart disease were all linked to elevated treatment expenses. There were no statistically significant differences in the direct medical expenses during hospitalization associated with treating severe MK, whether the culture results were positive or negative, or regardless of the type of cultured organism utilized.

Estimated direct and indirect health care costs of severe infectious keratitis by cultured organisms in Thailand: An 8-year retrospective study.

PURPOSE: To evaluate the economic impact of treating severe infectious keratitis (IK) at one tertiary referral center in Thailand by analyzing the direct costs of treatment and estimating the indirect costs, and to determine whether cultured organisms had any effect on treatment expenditure. METHODS: A retrospective study was conducted of patients with severe IK who had been hospitalized between January 2014 and December 2021 in Rajavithi Hospital. Data from medical records were collected from the time of the patients' admission until the point at which they were discharged and treated in the outpatient department and their IK was completely healed, or until evisceration/enucleation was performed. The direct costs of treatment included fees for services, medical professionals and investigation, as well as for operative and non-operative treatment. The indirect costs consisted of patients' loss of wages, and costs of travel and food. RESULTS: A total of 335 patients were studied. The median direct, indirect and total costs were US$65.2, range US$ 6.5-1,119.1, US$314.5, range US$50.8-1,067.5, and US$426.1, range 57.5-1,971.5 respectively. There was no statistically significant difference between direct, indirect, or total treatment costs for culture-negative and culture-positive patients. Among those who were positive, fungal infections entailed the highest total cost of treatment, and this difference was statistically significant (p<0.001). In terms of direct and indirect costs, patients with fungal infections had the greatest direct costs, and this figure was statistically significant (p = 0.001); however, those with parasitic infections had the highest indirect treatment costs, and this was also statistically significant (p<0.001). CONCLUSION: Severe IK can cause serious vision impairment or blindness. Indirect costs represented the majority of the expense at 73.8%. There was no difference between direct, indirect, and total treatment costs for patients who were culture-negative or positive. Among the latter, fungal infections resulted in the highest total cost of treatment.

The Classification of Common Macular Diseases Using Deep Learning on Optical Coherence Tomography Images with and without Prior Automated Segmentation.

We compared the performance of deep learning (DL) in the classification of optical coherence tomography (OCT) images of macular diseases between automated classification alone and in combination with automated segmentation. OCT images were collected from patients with neovascular age-related macular degeneration, polypoidal choroidal vasculopathy, diabetic macular edema, retinal vein occlusion, cystoid macular edema in Irvine-Gass syndrome, and other macular diseases, along with the normal fellow eyes. A total of 14,327 OCT images were used to train DL models. Three experiments were conducted: classification alone (CA), use of automated segmentation of the OCT images by RelayNet, and the graph-cut technique before the classification (combination method 1 (CM1) and 2 (CM2), respectively). For validation of classification of the macular diseases, the sensitivity, specificity, and accuracy of CA were found at 62.55%, 95.16%, and 93.14%, respectively, whereas the sensitivity, specificity, and accuracy of CM1 were found at 72.90%, 96.20%, and 93.92%, respectively, and of CM2 at 71.36%, 96.42%, and 94.80%, respectively. The accuracy of CM2 was statistically higher than that of CA (p = 0.05878). All three methods achieved AUC at 97%. Applying DL for segmentation of OCT images prior to classification of the images by another DL model may improve the performance of the classification.

Geographic Atrophy Phenotypes in Subjects of Different Ethnicity: Asia-Pacific Ocular Imaging Society Work Group Report 3.

OBJECTIVE: To characterize geographic atrophy (GA) and evaluate differences between Asians and non-Asians. DESIGN: Multicenter, retrospective case series. PARTICIPANTS: Subjects aged ≥ 50 years with GA secondary to age-related macular degeneration in the absence of neovascularization in the study eye and follow-up of ≥ 2 years. METHODS: The GA lesion characterized at baseline and last follow-up based on multimodal imaging (fundus autofluorescence [FAF], near infrared [NIR], and spectral domain-OCT). Patients were grouped as either Asian or non-Asian. MAIN OUTCOME MEASURES: Comparison of (1) phenotypes of GA lesions (size, foveal involvement, number of foci, drusen background, and choroid background) and (2) growth rates of GA. RESULTS: A total of 144 patients (169 eyes) with distribution of 50.9% Asians and 49.1% non-Asians. The age and sex were similar between Asians and non-Asians (Asians: mean age, 77.2 ± 10.1 years, 47.9% female; non-Asians: mean age, 79.7 ± 8.4 years, 58.7% female). Asians exhibited thicker choroids (167 ± 74 versus [vs.] 134 ± 56 µm; P < 0.01) and lower prevalence of drusen (40.7% vs. 66.3%; P < 0.01). At baseline, the GA area was smaller in Asians vs. non-Asians (NIR, 3.7 ± 4.6 vs. 6.3 ± 6.8 mm2; P = 0.01: FAF, 2.4 ± 3.4 vs. 8.4 ± 9.6 mm2; P < 0.01). Asians had fewer GA foci (1.7 ± 1.3 vs. 2.7 ± 2.2; P < 0.01) compared to non-Asians. The proportion with diffused or banded FAF junctional zone pattern was similar between Asians and non-Asians (44.2% vs. 60.2%; P = 0.20). Asians had a slower GA lesion growth rate than non-Asians (NIR, 0.7 vs. 1.9 mm2/year; P < 0.01: FAF, 0.3 vs. 2.0 mm2/year; P < 0.01: NIR, 0.2 vs. 0.4 mm/year; P < 0.01 square root transformed: FAF, 0.1 vs. 0.3 mm/year; P < 0.01 square root transformed). The factors associated with GA lesion growth rate are (from the highest effect size) ethnicity, junctional zone FAF pattern, baseline GA area, and number of GA foci. Higher GA lesion growth rate was observed in both Asian and non-Asian subgroups, with drusen or lesion size and FAF patterns meeting inclusion criteria of recent therapeutic trials, but growth rate remained significantly slower in Asians. Eyes with baseline lesion ≥ 5 mm2 showed the highest growth rate, and the difference between ethnicities was no longer significant (2.6 vs. 3.3 mm2/year; P = 0.14). CONCLUSIONS: There are differences in GA lesion phenotype, associated features, and growth rate between Asians and non-Asian subjects. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Characteristics of road traffic mortality and distribution of healthcare resources in Thailand.

Road traffic mortalities (RTMs), a leading cause of death globally, mostly occur in low- and middle-income countries, and having sufficient healthcare resources could lower the number of these fatalities. Our study aimed to illustrate the incidence of RTMs per 100,000 population and to compare the distribution of healthcare resources from 2011 to 2021 with rates of RTMs in the 77 provinces of Thailand. We divided the population into adults (≥ 15 years) and children (0-14 years). Lorenz curve and Gini coefficient were used to measure the level of distribution and equality of hospital resources and in relation to RTMs across the country. The average number of deaths was 30.34 per 100,000 per year, with male predominance. The RTM rates for adults and children were 32.71 and 19.08 per 100,000 respectively, and motorcycle accidents accounted for the largest percentage of deaths across all age groups. The Gini coefficient showed that operating rooms (0.42) were the least equally distributed hospital resource, while physicians were the most equally distributed (0.34). Anomalies were identified between the distribution of RTMs and available hospital resources. We hope our study will be beneficial in reallocating these resources more fairly to reflect the different numbers of traffic accidents in each province with the aim of reducing lower traffic-related deaths.

The Association Between Environmental and Social Factors and Myopia: A Review of Evidence From COVID-19 Pandemic.

Purpose: To review the association between children's behavioral changes during the restriction due to the pandemic of Coronavirus disease (COVID-19) and the development and progression of myopia. Design: A literature review. Method: We looked for relevant studies related to 1) children's behavioral changes from COVID-19 restriction and 2) children's myopia progression during COVID-19 restriction by using the following keywords. They were "Behavior," "Activity," "COVID-19," "Lockdown," "Restriction," and "Children" for the former; "Myopia," "COVID-19," "Lockdown," "Restriction" for the latter. Titles, abstracts and full texts from the retrieved studies were screened and all relevant data were summarized, analyzed, and discussed. Results: Children were less active and more sedentary during COVID-19 restriction. According to five studies from China and six studies, each from Hong Kong, Spain, Israel, South Korea, Turkey and Taiwan included in our review, all countries without myopia preventive intervention supported the association between the lockdown and myopia progression by means of negative SER change ranging from 0.05-0.6 D, more negative SER change (compared post- to pre-lockdown) ranging from 0.71-0.98 D and more negative rate of SER changes (compared post- to pre-lockdown) ranging from 0.05-0.1 D/month. The reported factor that accelerated myopia is an increase in total near work, while increased outdoor activity is a protective factor against myopia progression. Conclusion: The pandemic of COVID-19 provided an unwanted opportunity to assess the effect of the behavioral changes and myopia in the real world. There is sufficient evidence to support the association between an increase in near work from home confinement or a reduction of outdoor activities and worsening of myopia during the COVID-19 lockdown. The findings from this review of data from the real world may help better understanding of myopia development and progression, which may lead to adjustment of behaviors to prevent myopia and its progression in the future.

Evaluation of ocular biometry in primary angle-closure disease with two swept source optical coherence tomography devices.

PURPOSE: To investigate agreement between 2 swept source OCT biometers, IOL Master700 and Anterion, in various ocular biometry and intraocular lens (IOL) calculations of primary angle-closure disease (PACD). SETTING: Rajavithi Hospital, Bangkok, Thailand. DESIGN: Prospective comparative study. METHODS: This study conducted in a tertiary eye care center involving biometric measurements obtained with 2 devices in phakic eye with diagnosis of PACD. Mean difference and intraclass correlation coefficient (ICC) with confidence limits were assessed, and calculations of estimated residual refraction of the IOL were analysed using Barrett's formula. RESULTS: Sixty-nine eyes from 45 PACD patients were enrolled for the study. Excellent agreement of various parameters was revealed, with ICC (confidence limits) of K1 = 0.953 (0.861-0.979), K2 = 0.950 (0.778-0.98), ACD = 0.932 (0.529-0.978), WTW = 0.775 (0.477-0.888), and LT = 0.947 (0.905-0.97). Mean difference of axial length (AL) was -0.01 ± 0.02 mm with ICC of 1.000. IOL calculation was assessed with Barrett's formula, and Bland-Altman plot showed excellent agreement in the results of the 2 devices for the IOL power and estimated post-operative residual refraction (EPR). CONCLUSIONS: Mean differences of biometric parameters, obtained with IOL Master700 and Anterion, were small, and ICC showed excellent concordance. No clinical relevance in calculation of IOL power was found, and the two devices appeared to be comparably effective in clinical practice.

Clinical evaluation of ocular biometry of dual Scheimpflug analyzer, GALILEI G6 and swept source optical coherence tomography, ANTERION.

To evaluate the performance of a new swept source optical coherence tomography optical biometer, ANTERION, in ocular biometry and intraocular lens (IOL) calculation compared with the reference standard of Dual Scheimpflug Analyzer (GALILEI, G6). A prospective comparative study was conducted in a tertiary eye center. Cataract patients were scanned with both devices in a random fashion, and parameters from the devices were analyzed in terms of mean difference and intraclass correlation coefficient (ICC). Bland-Altman plots were performed to compare agreement between the devices. Ninety-six eyes from 96 patients were enrolled for evaluation. With the exception of ACD, all parameters were significantly different, but excellent agreement was revealed for all of them. The mean difference in axial length was 0.03 mm, and ICC was 0.999. Calculated IOL power with Barrett formula revealed that 93.75% were within 1 diopter and the prediction error was 0.03 diopter. Biometry of the devices were arithmetically different. However, the mean difference of the key factors in IOL calculation were small and appeared to be negligible for the purposes of clinical application. The performance of ANTERION was comparable to that of G6 in biometric measurement and IOL calculation; however, the devices cannot be used interchangeably.