Impact of the COVID-19 Lockdown on Ophthalmological Assistance in the Emergency Department at a Spanish Primary Level Hospital.

PURPOSE: To analyze the changes in ophthalmological emergencies during the COVID-19 pandemic lockdown at a Spanish primary level hospital. METHODS: The number and type of emergencies attended in the emergency department of Hospital Universitario del Henares between March 10 and August 31, 2020 (COVID-19 cohort) were compared with the emergencies attended during the same period of 2019 (pre-COVID-19 cohort). Data on the diagnosis, patient age, and gender was retrospectively collected from the electronic medical records of the hospital. The different diagnoses were organized into "clusters," which include those conditions that affect the same ocular tissue and that have similar clinical expression. RESULTS: The number of ophthalmological emergencies during the study period was 841, compared to 1343 during the same month of 2019, which represents a reduction of 37.4%. The percentage reduction in each cluster was as follows: conjunctiva (-65.4%), cornea (-35.8%), uveitis (-3.6%), eyelid and orbital and lacrimal (-35.5%), strabismus (-60%), neuro-ophthalmology (-11.8%), retina (-10.6%), cataract (+16.4%), glaucoma (-37%), and miscellaneous (-45.1%). The number of people seen with viral conjunctivitis decreased by -87.1% compared to 2019. Patients with complications due to conjunctivitis also decreased: patients with pseudomembranes dropped from 16 to 4 cases and patients with corneal subepithelial infiltrates from 9 to 3 cases. CONCLUSIONS: Most diagnostic clusters showed a similar decrease. Clusters that included vision-threating conditions (retina, neuro-ophthalmology, and uveitis) remained mostly stable. During the COVID-19 lockdown, the diagnosis of adenoviral conjunctivitis decreased nearly 10 times. This fact may represent a decrease in the transmission of these infections.

Influence of Main Ocular Variables in #TheDress Perception: An Ophthalmic Survey.

The objective of this study is to study the influence of ocular variables in the perception of #thedress and to develop a logistic regression model that could help predict it. This is a cross-sectional study on 1,100 subjects. People who did not report one of the two main perceptions were excluded from the study. Dress perception was codified as 0 (white&gold) or 1 (black&blue). The association between dress perception and demographic and main ocular variables (age, gender, binocular visual acuity, grade of nuclear cataract, crystalline lens status [phakic/pseudophakic], spherical equivalent, and ocular health status) was tested using logistic regression. Receiver operation curves were used to test the predictive value of the model. Several variables were found to be related with dress perception. The best model included three variables-Age: adjusted odds ratio (OR) = 1.02 (1.01-1.03), p = 0.08; ocular refraction: adjusted OR = 1.07 (1.02-1.12), p = 0.009; and nuclear cataract grade: adjusted OR = 1.45 (1.05-1.99), p = 0.026. The predictive value of the model was low (area under the curve = 0.62). Older age, nuclear cataract grade, and hyperopia were associated with black&blue perception. The predictive capacity of the developed model was poor. Only a small proportion of the variability in the #thedress perception can be explained by ocular examination.

Disc Configuration as a Risk and Prognostic Factor in NAION: The Impact of Cup to Disc Ratio, Disc Diameter, and Crowding Index.

Purpose: The presence of the so called disc at risk (a small disc with no cupping) has been considered the main risk factor for the development of non-arteritic anterior ischemic optic neuropathy (NAION). However its role as a prognostic factor has not been studied. Our aim was to determine the weight of disc configuration as a risk and a prognostic factor for NAION. Methods: Case control study. Forty eyes of 40 patients who were diagnosed with NAION between 2008 and 2017, and 120 controls (3 controls for each patient) were included in the study. Disc diameter (DD), cup to disc ratio (CDR), and peripapillar retinal nerve fiber layer thickness (RNFLT) of the non-affected eye were measured using optic coherence tomography (3D OCT 2000, Topcon). Crowding index (CI) was defined as the quotient of average RNFLT and disc area. Mean deviation (MD) at the time of diagnosis and at least three months later was determined using a Humphrey Visual Field Analyzer (SITA standard 24-2 strategy). Visual acuity (VA) was measured using Snellen charts and transformed into LogMAR values. Results: Only CDR was found to be a risk factor for NAION. No correlationship was found between CI and visual loss. Conclusions: DD and CI did not show value as either prognostic or risk factors. Glial tissue may be a part of the content of the optic disc as important as axons. Our results are in line with the latest studies about NAION pathophysiology. Contrary to classic thinking, these papers have not found smaller disc diameters, but smaller values of lamina cribosa depth in NAION patients.

The influence of meibomian gland loss on ocular surface clinical parameters.

PURPOSE: To assess the relationship between the meibomian gland loss (MGL) and relevant ocular surface clinical parameters as well as the influence of age in this relationship. METHODS: A total of 161 participants (mean age; 42±17 years) were enrolled in this study. Infrared meibography was performed using Keratograph 5M (K5M; Oculus GmbH, Wetzlar). Participants were divided into five groups according to total meiboscore and the ocular surface parameters of each MGL group were studied. In addition, the relationship between MGL and the ocular surface parameters was established including age as covariant. RESULTS: Both eyelids were taken into account since no association between the MGL from upper and lower eyelid was found (k value=0.2; p=0.3) despite they were significantly correlated (r= 0.3; p<0.001). No statistically significant differences were found in symptomatology among different MGL groups. Statistically significant differences were found among MGL groups in tear osmolarity (p=0.02), bulbar redness (p=0.04), corneal and conjunctival staining (p=0.01 and p=0.004, respectively). Despite this, only corneal staining showed a significant correlation with MGL when age was covariant (r=0.2; p=0.04). CONCLUSIONS: MGL higher than 50% seems to be accompanied by signs on the ocular surface. Furthermore, age demonstrated to be a relevant factor when assessing MGL. For this reason, future studies should compare age-matched groups in order to know the contribution of the MGL on the ocular surface and establish valid cut-off values for dry eye diagnosis.

Temporal and Spatial Correlation Between Choroidal Thickness and Visual Function in a Case of POEMS Syndrome.

PURPOSE: To report the correlation between visual function and subfoveal choroidal thickness (SChT) in a case of POEMS syndrome. CASE REPORT: A 53 year old man diagnosed with POEMS syndrome was referred due to blurred vision. Best corrected visual acuity (BCVA) was 0.5 in his right eye (RE) and 0.7 in his left eye (LE), with a mild perimetric defect in the RE. SChT was 356 and 263 µm in his RE and LE. After an autologous peripheral blood stem-cell transplantation, both visual and systemic symptoms improved. At the most recent visit, SChT was 284 and 222 µm in his RE and LE, BCVA was 1.2 in both eyes and the perimetric defects had improved. CONCLUSIONS: SChT was inversely correlated with visual function in space and time. Due to the high sensitivity of choroidal tissue to vascular endothelial growth factor, SChT might be useful to monitor disease activity in POEMS.

Cyclodialysis: an update.

Cyclodialysis is the result of the separation of the longitudinal ciliary muscle fibers from the scleral spur, which creates an abnormal pathway for aqueous humor drainage that may lead to ocular hypotony. For many years cyclodialysis was considered a treatment option for glaucoma. However, today it usually occurs as a complication of blunt trauma or more rarely as a complication of anterior segment ocular surgery. Ocular hypotony can lead to cataract development, optic disk swelling, refractive changes, and several retinal complications, making accurate identification and timely intervention of the cleft mandatory. Traditionally gonioscopy was the only available technique to diagnose and localize the cleft. However, other tests such as optical coherence tomography, magnetic resonance imaging, transillumination, and specially ultrasound biomicroscopy are now available for the diagnosis of cyclodialysis. Multiple treatment options are also available for this condition. Although medical treatment can be effective to close small clefts, surgery is needed in most patients to restore ocular pressure.

Iatrogenic diplopia [corrected].

Diplopia is a very disturbing condition that has been reported as a complication of several surgical procedures. The following review aims to identify the ocular and nonocular surgical techniques more often associated with this undesirable result. Diplopia is reported as an adverse outcome of some neurosurgical procedures, dental procedures, endoscopic paranasal sinus surgery, and several ophthalmic procedures. The most common patterns and some recommendations in order to prevent and treat this frustrating outcome are also given.

Impact of tamsulosin exposure on late complications following cataract surgery: retrospective cohort study.

The purpose of this study is to measure the impact of tamsulosin intake on five postoperative cataract surgery complications (toxic anterior segment syndrome, rebound uveitis, retinal detachment, macular edema, and postoperative endophthalmitis). This retrospective cohort study was conducted at University Hospital of Henares. The study included 660-eyes of 660 patients submitted to cataract surgery at the ophthalmology unit of Hospital del Henares (Madrid) between 2 March 2009 and 28 February 2010. Extracapsular cataract extraction, combined glaucoma and cataract surgery phacovitrectomy, posterior capsule rupture and zonular damage were considered exclusion criteria. Clinical charts were reviewed during July 2012. Patients were divided in two groups (exposed and non-exposed to tamsulosin). Cumulative incidence of toxic anterior segment syndrome, rebound uveitis, retinal detachment, macular edema and postoperative endophthalmitis were compared in both groups. Rebound uveitis (relative risk [RR] 3.39; confidence interval [CI] 1.63-7.08) and macular edema (RR 4.15; CI 1.06-16.22) were more common in the tamsulosin-exposed group. Retinal detachment had a similar incidence in both groups. We observed no cases of endophthalmitis or toxic anterior segment syndrome in either of the two groups. Tamsulosin exposure in this cohort was associated with a higher risk of rebound uveitis and macular edema but the other three studied postoperative complications had a similar incidence in both groups.

Relationship between macular pigment and visual acuity in eyes with early age-related macular degeneration.

PURPOSE: Today the extent to which MP impacts visual function in early AMD remains unclear. This study examines the relationship between macular pigment optical density (MPOD) and high-contrast visual acuity (HC-VA) and low-contrast visual acuity (LC-VA) in eyes with early age-related macular degeneration (AMD). METHODS: Measurements were made in 22 subjects with early AMD and 27 healthy control subjects. Distance best-corrected VA was measured using HC (96%) and LC (10%) Bailey-Lovie logMAR letter charts under photopic luminance conditions. MPOD was determined at the fovea through apparent motion photometry using the cathode ray tube-based Metropsis psychophysical vision test (Cambridge Research Systems). RESULTS: No significant differences in foveal MPOD were detected between the control eyes (0.30 ± 0.24 log units) and eyes with early AMD (0.27 ± 0.15 log units). Neither were differences detected between the two groups in mean HC- and LC-VA. Foveal MPOD showed significant correlation with both photopic HC-VA (r = -0.47, p = 0.0008) and LC-VA (r = -0.46, p = 0.0008) such that as MPOD increased, photopic HC-VA and LC-VA improved (lower logMAR values). CONCLUSIONS: Low MP levels were related to worse visual function in both healthy eyes and eyes with early AMD. Our findings provide direction for future studies designed to improve retinal function through the use of oral supplements known to increase MP levels, especially in eyes with AMD and a low MPOD.

Impaired mesopic visual acuity in eyes with early age-related macular degeneration.

PURPOSE: To determine photopic and mesopic distance high-contrast visual acuity (HC-VA) and low-contrast visual acuity (LC-VA) in eyes with early age-related macular degeneration (AMD). METHODS: Measurements were made in 22 subjects with early AMD and 28 healthy control subjects. Inclusion criteria included a photopic HC-VA of 20/25 or better. Distance VA was measured using HC (96%) and LC (10%) Bailey-Lovie logMAR letter charts under photopic (85 cd/m(2)) and mesopic (0.1-0.2 cd/m(2)) luminance conditions. RESULTS: Mean mesopic distance HC-VA and LC-VA were significantly worse (0.1 logMAR and 0.28 logMAR, respectively) in the early AMD group than in the control group. Under mesopic conditions, the mean difference between LC-VA and HC-VA was significantly greater in the early AMD (0.45 logMAR) than the control group (0.27 logMAR). Mean differences between mesopic versus photopic HC-VA and mesopic versus photopic LC-VA were significantly greater in the early AMD than the control group (0.13 and 0.32 logMAR of difference between the means, respectively). Sensitivity and specificity were significantly greater for mesopic LC-VA than for mesopic HC-VA (Receiver Operating Characteristics, area under the curve [AUC], 0.94 ± 0.030 and 0.76 ± 0.067, respectively). AUC values for photopic HC-VA and LC-VA were below 0.70. CONCLUSIONS: Visual acuity testing under low luminance conditions emerged as an optimal quantitative measure of retinal function in early AMD.

Factors that influence outcomes of hyperopic laser in situ keratomileusis.

PURPOSE: To analyze the influence of preoperative corneal curvature, postoperative keratometric power, and the amount of correction on the outcomes of hyperopic laser in situ keratomileusis (LASIK). SETTING: Clínica Baviera, Instituto Oftalmológico Europeo, Madrid, Spain. METHODS: In this retrospective study, the records of 376 eyes that had LASIK for hyperopia using the Moria LSK-One microkeratome and the Technolas-Keracor 217C excimer laser were reviewed. The results were analyzed by preoperative hyperopia (5 subgroups) and by preoperative (more than and less than 43.0 diopters [D]) and postoperative (more than and less than 48.0 D) mean keratometry. RESULTS: A statistically significant keratometry regression was found in the +3.00 to +3.90 D range (P <.01), a significant decrease in predictability in the +4.00 to +4.90 D range (P <.05), and a significant worsening in safety in the highest range (+6.00 to +7.90 D; P <.05). Comparative analysis of the > or = +4.00 D and <+4.00 D groups showed statistically significant differences in most measurement parameters. The preoperative keratometry did not influence postoperative results with the exception of poorer predictability in the group of preoperative flat corneas in which a high degree of hyperopia was corrected; ie, spherical equivalents within +/-0.50 D were found in 40.4% and 61.0% of cases with flat and steep corneas, respectively (P <.05). The efficacy and safety in eyes that achieved a postoperative keratometry >48.00 D did not differ significantly from the efficacy and safety in eyes that had a lower final keratometric power. CONCLUSIONS: The factor that negatively influenced the outcome of hyperopic LASIK was the degree of hyperopia corrected. Preoperative keratometry did not significantly influence the postoperative results, and postoperative keratometry >48 D did not result in significant worsening of visual results when the attempted correction was less than +4.00 D.