Passive Verification: A Flawed System Putting Patients' Sight at Risk.

OBJECTIVE: To assess the rate of erroneous or expired (invalid) contact lens prescriptions submitted for passive verification at two practice sites in Cleveland, OH. METHODS: Passive verification facsimile (FAX) requests were collected from office staff at a county hospital (MetroHealth [MH]), and at a private ophthalmology group office (University Ophthalmology Associates [UOA]) in Cleveland, Ohio, from January 2013 to January 2018. RESULTS: A total of 415 verification requests were evaluated (339 MH, 75 UOA), 28.2% (104 MH, 13 UOA) were expired, 11.8% (48 MH, one UOA) were not under the care of the doctor to whom the request was directed, 8.9% (32 MH, 5 UOA) were incorrect, and 3.9% (16 MH, 0 UOA) did not complete fitting. The total rate of invalid prescriptions was 52.8% (200 MH, 19 UOA). CONCLUSIONS: There is a high rate of invalid prescriptions presented for passive verification. Although the majority of prescriptions are simply expired, there is a fraction of prescriptions that contain incorrect specification of lens parameters or no record of prescription by that doctor. The current mechanism of passive verification, with the burden on the provider for denial within a short time window, makes it likely that such prescriptions would be filled, potentially putting patient comfort and safety at risk.

Outcomes for posterior uveal melanoma: Validation of American Brachytherapy Society Guidelines.

PURPOSE: To assess outcomes of small and medium choroidal melanoma (less than 5.0 mm in height) following Iodine-125 episcleral brachytherapy. METHODS AND MATERIALS: Patients with small and medium choroidal melanoma that underwent Iodine-125 brachytherapy with apical height of 1.0 mm to 5.0 mm and largest basal diameter of ≤16.0 mm were included. Data were extracted from the original dosimetry plans to determine doses to vision critical structures with the prescription point to the apical height (actual dose, ABS guidelines) and, after simulation, with the prescription point to the height of 5.0 mm (simulated dose, COMS protocol). Visual acuity (VA) outcomes with actual dose and that predicted with the simulated dose were estimated along with local recurrence, ocular survival, and survival at 5 years. RESULTS: A total of 339 patients with a mean age of 61.5 years with a mean follow up duration of 43.4 months were included. The mean dose reduction for lens, optic disc, and fovea was 34%, 39.4%, and 41.4%, respectively with actual dose when compared with simulated dose. The Kaplan-Meier estimations for 3 year event free rate of VA of 20/50 or better were 56% and 31% for actual dose and simulated dose, respectively. Only 3 events of local recurrence were observed (enucleated) yielding 5 year local control and ocular survival rate of 98%. Overall survival (OS) and metastasis free survival (MFS) were 95% and 87.5% at 5 years, respectively. CONCLUSIONS: Small and medium choroidal melanoma treated according to ABS has excellent outcomes. Brachytherapy planning using ABS guidelines as compared to COMS protocol may be associated with lower rates of radiation toxicity and vision loss.