A cost analysis of pediatric cataract surgery at two child eye health tertiary facilities in Africa.

PURPOSE: To determine the direct cost of pediatric cataract surgery at two child eye health tertiary facilities (CEHTFs) in Africa. METHODS: The direct cost of pediatric cataract surgery was determined by reviewing data collected from two CEHTFs in Zambia and Malawi. Inventory, cost, and usage data of all durable medical equipment, consumable equipment, personnel, and medications were collected and the direct cost per child calculated. RESULTS: For cataract surgery and related treatment during 2011, the total cost per child was calculated to be $202 for Malawi and $277 for Zambia using figures derived from estimating labor cost allocation proportional to employee time devoted to pediatric cataract management. The one-time equipment cost totaled $178,121 for Malawi and $179,832 for Zambia. CONCLUSIONS: These cost estimates may serve as a basis for economic decisions aimed at improving access to care, management, and follow-up for children with cataract and provide useful insights for programs dedicated to promoting organizational and financial sustainability for CEHTFs in Africa.

A novel tele-eye protocol for ocular disease detection and access to eye care services.

BACKGROUND: Telemedicine can improve access to care, especially for rural patients, and ophthalmology is a field that lends itself readily to telemedicine because interpretation of photographs is a routine part of diagnosing eye disease and patient care. We developed a novel tele-eye protocol based on diabetic teleretinal screening. We performed a feasibility study to see if our tele-eye program was comparable to the gold standard face-to-face eye exam. MATERIALS AND METHODS: Fifty-two subjects underwent the tele-eye protocol and then received a face-to-face exam. A masked reader reviewed the tele-eye data remotely and developed an impression and plan for the patient. The provider assessments from the face-to-face exams and the tele-eye exams were compared. Sensitivity, specificity, and percentage agreement were calculated for the tele-eye protocol, focusing on the most common age-related eye diseases: cataract, macular degeneration, and glaucoma. The difference between the autorefraction and manifest eyeglass prescription was calculated. RESULTS: The pilot study showed excellent percentage agreement between the screening protocol and the face-to-face exam. The percentage agreement for cataract was 100%, that for macular degeneration was 96%, and that for glaucoma suspect was 87%. The difference between the autorefraction's eyeglass prescription and the final manifest refraction was within American National Standards Institute for lens manufacturing guidelines. CONCLUSIONS: The initial data suggest that the tele-eye program is feasible to execute and appears fairly accurate when compared with the gold standard face-to-face eye exam. However, the study is significantly limited by the small sample size. This pilot provides justification of a much larger study of a similar design.

Visual outcome after Descemet's stripping automated endothelial keratoplasty in an 8-month-old with congenital hereditary endothelial dystrophy.

Descemet's stripping automated endothelial keratoplasty (DSAEK) has rapidly become the standard of care for endothelial dysfunction of the cornea in adults. There are few reports of DSAEK in children and infants, mainly because most pediatric corneal opacities are full-thickness and therefore not amenable to lamellar procedures but also because of the unique difficulties of performing this procedure in the youngest patients. We report the case of an 8-month-old girl who underwent DSAEK for congenital hereditary endothelial dystrophy. At 24 months' follow-up, her visual acuity was 20/40 in the operated eye. To our knowledge, this is the first report of an objective visual outcome in a child with DSAEK performed in infancy.

Veteran eye disease after eligibility reform: prevalence and characteristics.

PURPOSE: To determine the prevalence of eye disease in new "routine" eye patients at the Atlanta Veteran Affairs Medical Center. DESIGN: Retrospective chart review of all new eye patients seen in the Atlanta Veteran Affairs Medical Center Comprehensive Eye Clinic over a 2-month period (January 1, 2008-February 28, 2008). PARTICIPANTS: 691 charts met inclusion criteria, with 33 charts excluded for insufficient documentation in the medical record. This left a total of 658 charts for the study. METHODS: Charts were reviewed for the following information: demographic data, vision, ocular diagnoses (International Classification of Diseases, 9th Revision, Clinical Modification codes), and planned minor/laser/incisional surgical procedures. Additional data collected included whether glasses were prescribed and legal blindness. MAIN OUTCOME MEASURES: Vision-threatening ocular diagnoses and need for minor/laser/incision surgery were tabulated. RESULTS: There was a very high prevalence of potentially blinding disease in this population of new "routine" eye patients. About 63.4% of veterans were diagnosed with at least one ocular diagnosis other than refractive error; 25% had glaucoma or were suspects, 6% had cataracts, 5% had age-related macular degeneration, and 8% required a surgical procedure. CONCLUSION: The rate of ocular pathology is high in the veteran population.