Asynchronous Teleophthalmology for Monitoring Glaucoma Patients in a Rural German Region: A Retrospective Observational Pilot Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has created an escalating need for limiting in-person examination and potential viral exposure. Under these circumstances, teleophthalmology allows ophthalmologists to continue providing care to patients while ensuring their safety and that of the medical staff. OBJECTIVE: The primary objective of this study was to assess patient satisfaction with an asynchronous teleconsultation for glaucoma patients in a rural German area. Secondary endpoints were patient adherence and the need to change the therapeutic regime. METHODS: This retrospective, observational, and monocentric study included 50 patients diagnosed with primary open-angle glaucoma (n = 49) and ocular hypertension (n = 1) requiring medication to lower intraocular pressure (IOP). Only patients with well-controlled diseases were included, and a brief questionnaire was evaluated, which was completed one year after the baseline visit. Best-corrected visual acuity (BCVA), IOP measurements, visual fields, optical coherence tomography images of the optic nerve head, ultra-widefield photographs of the fundus, and photographs of the anterior segment of the eye were taken at each visit by an experienced optometrist. RESULTS: Of the 50 patients included, the mean number of follow-up visits in this observation period was 4.4. No patient was lost to follow-up, and there were a total of nine missed follow-up visits (but not lost to follow-up). No patients required a change in their treatment regime during the observational period. Regarding patient-focused assessment, the majority of patients were satisfied or very satisfied with teleconsultation in general. CONCLUSION: Asynchronous teleophthalmology is a promising option and effective means to monitor glaucoma patients. The majority of teleophthalmology patients were satisfied with their teleconsultation and adhered to the follow-up schedule. However, prospective trials with a larger number of patients and a more focused examination on specific patient populations are required. Further trials should also focus on the aspect of cost-effectiveness.

[Acquired Cataracts]. / Erworbene Katarakte.

Senile or age-related cataract is well known to ophthalmologists and also to colleagues in other medical specialties. Age-related cataract represents the most common cause of blindness worldwide but can be treated very successfully by a standard outpatient surgery. Far less common and therefore less known is the acquired cataract that can present a diagnostic and surgical challenge. The following article provides the reader with an overview of secondary acquired cataracts. The most common subtypes are mentioned first and then discussed in more detail so that the reader should have a structured knowledge after reading this article. This article focuses on acquired cataracts primarily in adults and highlights the surgical features including perioperative characteristics.

[Causes, Diagnosis and Therapy of Negative Dysphotopsia]. / Ursachen, Diagnose und Therapie der negativen Dysphotopsie.

Negative Dysphotopsia (ND) is a dark, sometimes rounded bar or shadow in the temporal visual field after uncomplicated cataract surgery that may lead to great patient discomfort. R. Olson called it "the number one troublesome complaint after uneventful cataract surgery". The origin of this phenomena remains uncertain and is discussed conversely in literature. We have found evidence that it may be caused by a slight difference in magnification caused by the new IOL compared to the old crystalline lens. This may lead to a minimal shift of the object space corresponding the blind spot and the larger central vessels so they become visible for a short time after surgery. Until now, no definitive criteria have been published for a proper diagnosis of ND. Based on our experience with 55 patients (77 eyes) with ND, out of 6,031 cataract procedures during the last two years, the following aspects seems to be important: ND is always 1) a disturbing dark shadow in the temporal visual field after cataract surgery and lens implantation. 2) No pathology of the eye can be found to explain this shadow. 3) In most cases, the following points exist in descending order of importance: The patients feel that the ND-shadow is far in the periphery of the visual field, mostly between 60° and 90°; using objective criteria, the shadow is, in reality, mostly between 10° and 25° in the temporal visual field; ND is variable; temporal illumination diminish ND in most patients; the correction of even the smallest refraction diminishes ND in most patients; if the hands of the examiner are placed alongside the patient's head-like blinders-ND will diminish in most cases; in monocular examination ND may diminish. Before surgery, each patient must be informed about dysphotopsia. Therapy is gradually phased in three steps: 1) ND should be explained by showing an image of the retina, saying, that the shadow is not the border of the IOL, but probably the border of the optic nerve and that all patients get used to that within a few weeks. This calms all patients. 2) If ND lasts too long from the point of view of patients, glasses should be tried, even with very moderate refraction, until ND disappears. 3) If patients do not wish to wear glasses, even for a little while, occlusion for some weeks causes ND to disappear. Only 2 of our 77 eyes with ND out of 6,031 cataract procedures required occlusion therapy, revision surgery was not necessary in any case.

Optical and material analysis of opacified hydrophilic intraocular lenses after explantation: a laboratory study.

BACKGROUND: The opacification of hydrophilic intraocular lenses (IOLs) is a very rare complication in terms of absolute numbers. We report on the analyses of opacified Euromaxx ALI313Y and ALI313 IOLs (Argonoptics, Germany) using light and scanning electron microscopy, X-ray spectroscopy and optical bench analysis. METHODS: Opacified Euromaxx ALI313Y and ALI313 IOLs were explanted after patients presented with a decrease in visual acuity. The explants were sent to our laboratory and examined using light and scanning electron microscopy. The composition of the deposits was analysed using X-ray spectroscopy. The optical quality of the intraocular lens (IOL) was assessed using the OptiSpheric IOL PRO optical bench (Trioptics GmbH Wedel, Germany). Modulation transfer function (MTF) was measured at all spatial frequencies and United States Air Force (USAF) 1951 resolution target pictures were documented. RESULTS: Macroscopically, the entire optic was opacified in all IOLs. Light and scanning electron microscopy revealed numerous fine, granular, crystalline-like deposits, which were always distributed in a line parallel to the anterior and posterior surfaces of the IOLs. X-ray spectroscopy could prove the deposits consisted of Calcium and Phosphate. Measurements in the optical bench showed deterioration of MTF values at all spatial frequencies and the USAF target pictures demonstrated a significant reduction of brightness as well as resolution with the opacified IOLs. CONCLUSIONS: The calcification of hydrophilic IOLs only occurs rarely. The exact chemical composition of the deposits can be assessed by means of X-ray spectroscopy. Optical quality analysis of the explanted Euromaxx ALI313Y and ALI313 IOLs showed significant reduction of MTF values, which was confirmed by USAF target pictures.

Is the Memory Effect of the Blind Spot Involved in Negative Dysphotopsia after Cataract Surgery?

We present novel clinical observations on negative dysphotopsia (ND) in eyes that have undergone cataract surgery. In the past, shadow effects were alleged to be located in the far peripheral temporal visual field 50° to 100° away from the optical axis. In a small series of eight patients we found evidence of photic effects, described by the patients as shadows in the periphery that were objectively located much more centrally. In all cases, we could find an association of these phenomena with the blind spot. We hypothesize that the memory effect of the blind spot which is dislocated and changed in magnification due to replacement of the crystalline lens could be one determinant for pseudophakic ND. The scotoma of the optic nerve head and the main arteries and veins of the phakic eye are displaced in the pseudophakic eye depending on the specific characteristics and position of the intraocular lens within the eye.

Influence of the prediction error of the first eye undergoing cataract surgery on the refractive outcome of the fellow eye.

INTRODUCTION: In addition to measurement errors, individual anatomical conditions could be made responsible for unexpected prediction errors in the determination of the correct intraocular lens power for cataract surgery. Obviously, such anatomical conditions might be relevant for both eyes. The purpose of this study was to evaluate whether the postoperative refractive error of the first eye has to be taken in account for the biometry of the second. METHODS: In this retrospective study, we included 670 eyes of 335 patients who underwent phacoemulsification and implantation of a foldable intraocular lens in both eyes. According to the SRK/T formula, the postoperative refractive error of each eye was determined and compared with its fellow eye. RESULTS: Of 670 eyes, 622 showed a postoperative refractive error within ±1.0 D (93%), whereas the prediction error was 0.5 D or less in 491 eyes (73%). The postoperative difference between both eyes was within 0.5 D in 71% and within 1.0 D in 93% of the eyes. Comparing the prediction error of an eye and its fellow eye, the error of the fellow eye was about half the value of the other. CONCLUSION: Our results imply that substitution of half of the prediction error of the first eye into the calculation of the second eye may be useful to reduce the prediction error in the second eye. However, prospective studies should be initiated to demonstrate an improved accuracy for the second eye's intraocular lens power calculation by partial adjustment.

[Indirect traumatic rupture of the globe without conjunctival injury]. / Gedeckte Bulbusruptur.

BACKGROUND: Blunt injuries are frequent causes of ocular trauma. Rupture of the globe without conjunctival injury following ocular contusions may be as dangerous as ruptures with opened conjunctiva, but is much more difficult to diagnose. PATIENTS AND METHODS: Retrospective analysis of 13 inpatients of the University Ophthalmological Hospital in 1991-1995 with rupture of the globe but without conjunctival injury following ocular contusion. These were 5 % of all the patients with through-through injuries of the eye wall. RESULTS: The characteristic finding in all 13 patients has been hyposphagma, hyphema, vitreal haemorrhage and loss of visual acuity to "finger counting" or less. At the time of the first examination, in 6 of the 13 patients intraocular pressure was between 3 mm Hg and 16 mm Hg. One patient had had an initial pressure of 3 mm Hg, but at the time of surgery, the eye had a stable normalized pressure. Postoperatively three of the 13 patients attained final visual acuities between 80/200 and 140/200 after at least 6 months, the remaining patients achieved not more than 5/200. CONCLUSION: In patients after blunt eye trauma rupture of the globe may occur in patients without damaging the conjunctiva and with normalised intraocular pressure. In such cases with intraocular bleeding and loss of vision it may be essential to open the conjunctiva and explore the sclera in order to be sure that there has not been a rupture of the sclera and to have the opportunity to perform pars-plana vitrectomy in time.