Refractive Outcomes Using Intraoperative Aberrometry for Highly Myopic, Highly Hyperopic, and Post-refractive Eyes.

PURPOSE: To evaluate whether intraoperative aberrometry improves the accuracy of refractive outcomes after cataract surgery in highly myopic, highly hyperopic, and post-refractive eyes. METHODS: This single-center, retrospective review compared the spherical equivalent of postoperative refraction to that predicted by the Barrett Universal II formula versus Optiwave Refractive Analysis (ORA) (Alcon Laboratories, Inc) for highly myopic and hyperopic eyes and to the Barrett True K formula versus ORA for post-refractive eyes. The number and magnitude of lens changes were analyzed and used to determine in how many cases refractive surprises were affected by ORA, with additional subanalysis of outcomes based on average keratometry values. RESULTS: ORA led to a change in the lens power implanted in 48% (96 of 198) of eyes, and prevented hyperopic surprise in 27% (15 of 55) and excess myopia in 46% (19 of 41). Steeper keratometry values correlated with more frequent changes on ORA-recommended implanted intraocular lens (P = .0031). ORA led to a similar percentage of eyes falling within ±0.50, ±0.75, and ±1.00 diopters compared to the Barrett Universal II and Barrett True K formulas. In post-refractive eyes, ORA led to a similar mean absolute error when compared to the Barrett True K formula (P = .62). For highly myopic eyes with an axial length of greater than 27 mm, ORA demonstrated a trend toward lower mean absolute error when compared to the Barrett Universal II formula (P = .076). CONCLUSIONS: ORA demonstrated similar refractive results to the Barrett True K formula in post-refractive eyes and to the Barrett Universal II formula in highly myopic and hyper-opic eyes and may provide additional benefit for eyes with steeper corneas or an axial length of greater than 27 mm. [J Refract Surg. 2021;37(9):609-615.].

Computer-assisted quantification of pre-plus and plus disease in images obtained using Pictor versus video indirect ophthalmoscopy: a pilot study.

Subjectivity in the diagnosis of plus disease in retinopathy of prematurity has prompted the creation of computer programs to objectively measure vascular characteristics. ROPtool is a semiautomated computer program that analyzes retinal vascular dilation and tortuosity. To explore its ability to trace images taken with a FDA-approved, portable, handheld noncontact digital fundus camera (Pictor), we compared ROPtool analysis of Pictor still images acquired by nonophthalmologists to video indirect ophthalmoscopy (VIO) still images acquired by ophthalmologists. ROPtool could trace more Pictor versus VIO images. In addition, receiver operating characteristic curves showed that accuracy for diagnosing pre-plus or plus disease was higher using Pictor versus VIO images.

Facilitated Versus Self-guided Training of Non-ophthalmologists for Grading Pre-plus and Plus Disease Using Fundus Images for Retinopathy of Prematurity Screening.

PURPOSE: Retinopathy of prematurity (ROP) is an important cause of preventable blindness; barriers to screening necessitate novel approaches. Although trained non-ophthalmologists can accurately grade retinal images for ROP, effective training protocols are not established. This study compares the effectiveness of facilitated versus self-guided training of non-ophthalmologists for grading retinal images for pre-plus or plus disease in ROP. METHODS: Forty-eight undergraduate and graduate students were trained to grade retinal images for the presence of pre-plus or plus disease. Students were randomly assigned to one of two training protocols. Both used identical electronic slideshows: one was guided by an in-person facilitator and the other was self-guided. After completing their respective training, students proficient in grading pre-plus and plus disease graded images in a telemedicine screening scenario. Accuracy of grading was compared to the reference standard of clinical examination. RESULTS: Eighty-three percent (40 of 48) of trained students (91% in the facilitated vs 77% in the self-guided group, P = .26) were proficient and qualified to grade the ROP telemedicine screening scenario. Median accuracy for grading normal, pre-plus, or plus disease was 69% (70% in the facilitated vs 68% in the self-guided group, P = .91). When considering the designation of pre-plus or plus disease by graders as a screening test for detecting plus disease (confirmed on clinical examination), the median sensitivity and specificity of all students were 95% and 64%, respectively. CONCLUSIONS: Both facilitated and self-guided teaching protocols yielded similar performance in ROP image grading for pre-plus or plus disease. Self-guided training protocols may be adequate to train non-ophthalmologists to grade retinal images for pre-plus and plus disease with high sensitivity. [J Pediatr Ophthalmol Strabismus. 2016;53(3):179-185.].