Prospective Assessment of Adjuvant Netarsudil Use in Patients Undergoing Descemet Stripping Only.

PURPOSE: We sought to determine whether adjuvant use of netarsudil improves corneal clearance rate and regeneration of corneal endothelial cells in patients undergoing Descemet stripping only (DSO). METHODS: We conducted a prospective assessment on the use of adjuvant netarsudil in 50 eyes from 25 patients undergoing DSO at Massachusetts Eye and Ear between May 2021 and May 2023. Our comparison group was a retrospective cohort of patients (23 eyes from 15 patients) who previously underwent DSO without the use of a postoperative rho-kinase inhibitor between September 2014 and March 2020. RESULTS: Use of netarsudil after DSO statistically significantly reduced time to corneal clearance, improved best corrected visual acuity, reduced pachymetric thickness, and increased central endothelial cell count (ECC) at 6 months postoperatively. Importantly, central ECC continued to increase beyond 12 months after DSO with central ECC still statistically significantly greater in eyes that received netarsudil than in eyes that received no netarsudil. CONCLUSIONS: A rho-kinase inhibitor, such as netarsudil, after DSO should be used if available to achieve the best corneal clearance, best corrected visual acuity, and ECC after surgery.

Aberrant regeneration of accommodation in pediatric inferior division oculomotor palsy.

Aberrant regeneration occurs in forms of oculomotor motor nerve palsy and frequently involves the pupil, but the incidence and functional impact of ciliary muscle involvement in pediatric patients is sparsely reported in the literature. A 4-year-old girl presented with inflammatory oculomotor motor nerve paresis affecting the inferior division. Initial treatment focused on her inability to accommodate through her physiologic +2.5 D hyperopia and the prevention and treatment of amblyopia. She subsequently developed aberrant regeneration of the pupil, with miosis on adduction. Following eye muscle surgery for residual exotropia and hypertropia, her dry refraction was noted to be more myopic in the affected eye on adduction, mirroring aberrant pupillary constriction. Recognition of pediatric aberrant regeneration of accommodation may influence surgical planning for oculomotor nerve palsy and/or management of amblyopia.

Content, Readability, and Accountability of Online Health Information for Patients Regarding Blue Light and Impact on Ocular Health.

Objective To evaluate the quality and readability of online health content regarding the ocular health effects of blue light. Methods Five commercial and five non-commercial websites with content regarding the ocular effect of blue light were examined. Quality evaluations were conducted using a 14-question assessment composed by the authors and the 16-question DISCERN instrument. Website accountability was evaluated via the Journal of the American Medical Association (JAMA) benchmarks. Readability was determined using an online tool (Readable). Correlational and comparative analyses were conducted where appropriate. Results The average questionnaire score was 84 (standard deviation [SD] ± 17.89, 95% confidence interval [CI] 77.32-90.68) out of 136 points (61.8%). Significant differences in quality were identified between websites (p = 0.02), with Healthline achieving the highest score. Compared to commercial websites, non-commercial websites trended toward having significantly higher median questionnaire scores (p = 0.06). Zero websites achieved all four JAMA benchmarks. The average reading grade level of content was 10.43 (SD ± 1.15, 95% CI 9.60 - 11.25), with differences between websites trending toward significance (p = 0.09). There was no correlation between resource readability and quality (ρ = 0.28; p = 0.43) or accountability (ρ = 0.47; p = 0.17). Conclusions There remain substantial deficiencies in the quality, accountability, and readability of online content concerning the effect of blue light on ocular health. Clinicians and patients must recognize such issues when recommending and consuming these resources.

Use of Informational Brochures on Knowledge of Cataracts in Rural Ecuador.

Background Cataracts are the leading global cause of preventable blindness. Despite the high prevalence of cataracts in rural Ecuadorian communities, no community-wide educational efforts on the impact of cataract-related blindness have been attempted. This study used an educational brochure to assess individual knowledge of cataract blindness before and after the distribution of the brochure. Methods We conducted electronic surveys with 100 patients over the age of 18 who visited the Fundacion Internacional Buen Samaritano Paul Martel (FIBUSPAM) clinic serving the Chimborazo region of Ecuador. Participation in the study included an introduction and written consent followed by a pre-survey. Every patient was given a brochure. After reviewing the brochure, patients were then asked to complete the same survey again. Each survey question received one mark. Knowledge was considered "good" if the subject correctly answered four out of seven questions and "poor" if they scored ≤3. Results Of the 100 patients, 21 had poor knowledge surrounding cataracts. Cataract awareness was lowest in the group without formal education (50%). In addition, 17 participants demonstrated poor knowledge before the informational brochure was distributed, and all improved to "good" knowledge after. Following brochure distribution, there was an improved knowledge of cataract anatomy (correct answer: 32.9% to 94.6%), treatment of cataracts (80% to 95.9%), cataract symptoms (36.7% to 95.9%), age at risk (88.8% to 97.3%), and relationship to blindness (93.5% to 98.6%). In contrast, overall knowledge of the risk factors for cataracts (46.8% to 37%) and prevention of the onset of the cataract (81.3% to 77%) slightly decreased after the brochure was given. Overall, the increase in the number of correct answers after the brochure was not significant (p = 0.25). Conclusions To our knowledge, this is a rare study to assess the effect of informational brochures on cataract knowledge in rural Ecuador. This study was limited by selection bias and did not look at the long-term recall of knowledge. The results of this study suggest that brochures can improve health awareness; however, brochures alone may not be enough. Additional assessments on the use of oral and visual aids are needed. Health education efforts should go beyond simple brochures and focus on innovative strategies to improve health education and communication efforts.

Recurrence of Guttae and Endothelial Dysfunction After Successful Descemet Stripping Only in Fuchs Dystrophy.

PURPOSE: There are limited data about long-term durability of endothelial rejuvenation after Descemet stripping only (DSO). This study reports a case of bilaterally recurrent endothelial dysfunction and guttae formation after initially successful DSO in combination with cataract extraction (DSO-CE). METHODS: This is a retrospective case report. A 49-year-old man with Fuchs endothelial corneal dystrophy with bilateral visually significant endothelial guttae (predominantly confluent centrally) and concomitant cataract underwent DSO-CE bilaterally. Postoperative course to long-term outcome at 6 years was analyzed. RESULTS: Baseline central corneal thickness (CCT) was 568 µm in OD and 582 µm in OS. Preoperatively, both eyes had no countable central endothelial cells but good peripheral endothelial mosaic. In both eyes, the cornea clinically cleared at approximately 1 month postoperatively after DSO-CE. In short-term follow-up (OD postoperative month 6 and OS postoperative month 3), CCT was 556 µm in OD and 561 µm in OS and central endothelial cell density was 1352 cells/mm 2 in OD and 880 cells/mm 2 in OS. The patient returned to our center in postoperative year 6 OU. At this time, OU had interval formation of guttae within the descemetorhexis, with increased CCT (OD 631 µm and OS 609 µm) and decreased central endothelial cell density (OD 728 cells/mm 2 and OS 609 cells/mm 2 ). CONCLUSIONS: After DSO, progressive endothelial dysfunction with new guttae formation can occur within the descemetorhexis region of repopulated endothelium. Larger analyses with longer follow-up are needed to better characterize long-term outcomes of DSO.

Pinguecula with spheroidal degeneration: clinicopathologic correlation.

Clinicopathologic correlation of a pinguecula with spheroidal degeneration: a benign entity occasionally encountered in clinical practice.

Impact of SARS-CoV-2 on Ocular Surface Pathology and Treatment Practices: a Review.

PURPOSE OF REVIEW: The ocular surface is a potential site of ocular involvement by SARS-CoV-2 infection. We performed a review of the literature to understand the pathogenesis of SARS-CoV-2 disease manifestations on the ocular surface as well as to elucidate emerging treatment patterns and practice changes during the COVID-19 pandemic. RECENT FINDINGS: The ocular manifestations of SARS-CoV-2 are likely limited to a mild and transient conjunctivitis. Other manifestations have not been validated in larger cohorts. Ocular surface tissue should be considered potentially infectious due to the presence of host receptors on surface tissues. The availability of donor tissue in lower-middle income countries has been greatly impacted by the pandemic and would benefit from further investigation into transmissibility through donor tissue. SUMMARY: Transmission of SARS-CoV-2 through the ocular surface has yet to be confirmed. The most common ocular manifestation is a mild conjunctivitis. Ocular surface surgeons face specific challenges in the use of donor tissues and aerosolizing procedures and have adapted practice patterns accordingly.

Penetrating keratoplasty using collagen crosslinked donor tissue: A case report.

PURPOSE: In patients with corneal melt, pretreatment crosslinking (CXL) of donor tissue prior to placement of Boston keratoprosthesis (K-Pro I) decreases graft failure. We report a case of corneal sparing in a phthisical eye following penetrating keratoplasty (PKP) with pretreatment CXL of the donor cornea. OBSERVATIONS: A 69-year-old female with a history of familial aniridia and bilateral K-Pro I placement. Her clinical course was complicated by recurrent corneal melt and hypotony in the left eye, resulting in extraction of the K-Pro I and successive PKP with pretreatment CXL of the donor cornea. She subsequently developed phthisis of the globe with notable retention of corneal structure. At 8 years, she maintains corneal contour without recurrence of keratolysis or extension of phthisis. CONCLUSIONS AND IMPORTANCE: This is the first reported case of corneal sparing in a phthisical eye with a history of PKP, suggesting a protective role of pretreatment CXL of donor tissue against keratolysis and phthisis.

Association of Weight Gain Acceleration With Risk of Retinopathy of Prematurity.

IMPORTANCE: Early slow postnatal weight gain, a surrogate for low insulinlike growth factor 1 (IGF-1) levels, is predictive of retinopathy of prematurity (ROP). While low IGF-1 levels inhibit retinal vessel growth, a later rise theoretically activates vascular endothelial growth factor, causing neovascularization. Rate of rise of IGF-1 level is represented by weight gain acceleration (WGA) and may be used to evaluate risk of ROP. OBJECTIVE: To evaluate whether faster WGA during a later postnatal period is associated with a higher, rather than lower, risk of severe ROP. DESIGN, SETTING, AND PARTICIPANTS: This secondary analysis of data from the Postnatal Growth and Retinopathy of Prematurity (G-ROP) study included 6835 infants undergoing ROP examinations from 29 hospitals in North America from January 2006 to June 2012. Data were analyzed from September to December 2016. MAIN OUTCOMES AND MEASURES: Early weight gain rate (WGR) during 29 to 33 weeks' postmenstrual age and late WGA during 34 to 38 weeks' postmenstrual age were determined using linear regression of daily weight measurements and changes in daily weight measurements, respectively. The primary outcome was the association of late WGA with severe ROP. RESULTS: Of the 6835 included infants, the mean (SD) birth weight was 1086 (357) g, and the mean (SD) gestational age was 27.9 (2.5) weeks. Risk of severe ROP increased with increasing late WGA up to about the 80th percentile of WGA. After adjusting for birth weight and gestational age, among infants in the lowest early WGR tertile, there was no association of late WGA with severe ROP, and among infants in the moderate and highest early WGR tertiles, the moderate WGA tertiles had the highest risk of ROP (moderate early WGR tertile: adjusted odds ratio, 1.38; 95% CI, 0.98-1.94; highest early WGR tertile: adjusted odds ratio, 1.63; 95% CI, 1.02-2.60). CONCLUSIONS AND RELEVANCE: Although much attention has been paid to the association of slow weight gain with ROP, the association may be more complex than appreciated. These findings suggest that low early WGR is associated with severe ROP regardless of subsequent WGA, but if early WGR is moderate or high, subsequent rapid rises in WGR are associated with increasing risk of severe ROP. If validated in additional cohorts, this finding may affect potential therapies, such as the timing of IGF-1 supplementation.

Visual Health and Visual Healthcare Access in Refugees and Displaced Persons: A Systematic Review.

Vision impairment is a significant global health concern. Still, there remains a gap in our knowledge of visual health in refugees. We conducted a systematic review of the distinctive eye care needs of refugees. We screened PubMed, EMBASE, and Web of Science through February 17, 2017 for studies that focused primarily on visual health in refugees. Risk of bias was assessed using the National Heart, Lung, and Blood Institute quality assessment tools. 26 studies were included in the final review. The prevalence of blindness ranged from 1.3 to 26.2%. Trachoma was the leading infectious cause. Only four studies assessed vision-related care. Time/location of displacement, social unrest, and sanitation impacted severity of eye disease. Refugees have unique eye care needs. Public health interventions should target eye care at every stage of displacement. Providers may use these results to inform future research and improve visual healthcare access in refugee groups.

Presence of Vision Impairment and Risk of Hospitalization among Elderly Medicare Beneficiaries.

PURPOSE: To examine the association between vision impairment and all-cause hospitalization among elderly Medicare beneficiaries. METHODS: A population-based study (N = 22,681) of community-dwelling Medicare beneficiaries aged 65 years and older who participated in the Medicare Current Beneficiary Survey for the years 2001-2007. Beneficiaries were classified into self-reported presence of vision impairment versus no vision impairment. Inpatient hospitalizations were identified using Medicare claims data. A multivariable Cox proportional hazard model examined the association between presence of vision impairment and time to first hospitalization within 3 years of survey entry after adjusting for sociodemographics, comorbidities, hearing impairment, and activity limitation stages derived from difficulty performing the activities of daily living. RESULTS: Medicare beneficiaries who self-reported the presence of vision impairment were significantly more likely to be hospitalized over 3 years compared to beneficiaries without vision impairment even after adjustment for potentially influential covariates (hazard ratio = 1.14 and 95% confidence interval: 1.05-1.23). CONCLUSIONS: Medicare beneficiaries with self-reported vision impairment were at higher risk of hospitalization during a 3-year period. Further research may identify reasons that are amenable to policy interventions.