Teleophthalmology-Enabled Direct Vitreoretinal Surgery Listing from Community Optometric Practice: Enhanced Efficiency During Coronavirus Disease 2019, and Beyond?

Purpose: To share a method of appropriately connecting patients directly to tertiary ophthalmology centers where subspecialist vitreoretinal (VR) surgical management is required during coronavirus disease 2019 (COVID-19). Methodology: We present our experience of a live teleophthalmology link directly connecting an optometrist to tertiary center VR team at the point of retinal detachment presentation within the community. Results: After the COVID-19 lockdown in National Health Service Forth Valley, Emergency Eye Care Treatment Centers have been set up where optometrists are the first point of contact for patients in the community. Live teleophthalmology link has enabled the optometrist in the community to connect directly with local ophthalmologists. From March 23 to June 15, 2020, five referrals were taken for a suspected retinal detachment, and one for submacular hemorrhage. From the receiving ophthalmologists' viewpoint, satisfaction for the quality of sound, video, and connection was 5/5 in all cases on a 5-point Likert grading; from the referring optometrists' viewpoint mean 4.6/5 for sound and video satisfaction, and 5/5 rating in all cases for connection reliability. On 5/6 occasions (83%) the receiving ophthalmologist connected directly with a VR surgeon in a tertiary center. Four-way communication between the patient, optometrist, receiving ophthalmologist, and VR surgeon enabled all five patients to be listed directly for VR surgery from the community, avoiding local ophthalmology department contact during the COVID-19 pandemic. Conclusion: Overall satisfaction and recommendation to others was rated 5/5 in all instances on a 5-point Likert grading, from the patient, optometrist, and ophthalmologist viewpoint.

Incidence of submacular haemorrhage (SMH) in Scotland: a Scottish Ophthalmic Surveillance Unit (SOSU) study.

PURPOSE: Submacular haemorrhage (SMH) is a cause of severe visual loss in neovascular age-related macular degeneration (nAMD). The incidence is uncertain and furthermore there is no widely used classification system nor agreed best practice. The aim of this national surveillance study was to identify the incidence, presenting features and clinical course of new fovea-involving submacular haemorrhage associated with nAMD. METHODS: A questionnaire was sent monthly to every ophthalmic specialist in Scotland over a 12-month period asking them to report all newly presenting patients with acute SMH secondary to nAMD of at least two disc diameters (DDs) in greatest linear diameter. A follow-up questionnaire was sent 6 months after initial presentation. Cases related to other causes were excluded. RESULTS: Twenty-nine cases were reported giving an incidence of 5.4 per million per annum (range 2-15). The mean age was 83 years (range 66-96) and females accounted for 17/29 (59%). Fifteen of the 29 cases (52%) had a past history of AMD, of which 7 had nAMD. Nineteen of the 29 cases (66%) presented within 7 days of onset and the majority had SMH of < 11 DD (20/29, 69%). Treatment options comprised the following: observation (n = 6, 21%), anti-VEGF alone (n = 6, 21%) or vitrectomy with co-application of tissue plasminogen activator (TPA), anti-VEGF and gas (n = 17, 58%). The vitrectomy group experienced the greatest change in vision from logMAR 1.89-1.50 (p = 0.374). Four of 20 (20%) cases with 6 months follow-up suffered a re-bleed at a mean time of 96 days. CONCLUSIONS: The incidence, clinical features and course of a consecutive national cohort of patients with SMH secondary to nAMD are presented.

QUIET PLEASE! Effect of distraction on simulated posterior segment surgical performance.

PURPOSE: To determine the effect of distraction on posterior segment surgical performance using a virtual reality simulator in expert and novice ophthalmic surgeons. METHODS: Twenty subjects were given 6 min to read an unpublished research paper and then were randomized into two groups. Group 1 subjects were allowed 3 min to complete a standardized vitreoretinal simulated task undistracted. Group 2 subjects were asked six questions on the research paper whilst completing the same task. Each subject then performed the alternate scenario. Finally, all participants were asked six questions on the research paper whilst not operating. RESULTS: There was no evidence of a difference in the odometer values (p = 0.127), cognitive task score (p = 0.390) or overall surgical task scores (p = 0.113) between the two groups. The time taken by the distracted group was significantly greater (95% CI -26.03 to -1.67, t-test p = 0.028). CONCLUSION: Distraction significantly increases the time taken to perform a simulated vitreoretinal surgical task for all grades of surgeon. More studies are required to understand the impact on different types of distraction on surgical performance.

The Pulfrich phenomenon; clumsiness and collisions which can be ameliorated.

The Pulfrich phenomenon has been described many times but usually just as an interesting academic issue with only diagnostic significance. The phenomenon is due to the fact that patients with unilateral optic neuropathy due to ischaemia, facial injury or multiple sclerosis may have delayed transmission of retinal responses to light from one eye to the brain. This leads to an altered and incorrect interpretation of the pathway and direction of moving targets. Clinicians should be aware of the unique symptomatology of the Pulfrich phenomenon because it is often difficult for patients to describe their symptoms which can be both unpleasant and troublesome. An appropriate tint in either a spectacle or contact lens over the normal eye delays retinal conduction, so re-establishing visual processing symmetry and ameliorating the symptoms.