Superior Visual Field Testing Using Virtual Reality With and Without Eye Tracking for Functional Upper Eyelid Surgery Evaluation: A Pilot Study.

PURPOSE: To assess the sensitivity and specificity of superior visual field tests administered in virtual reality (VR) with eye tracking (VR-ET) and without eye tracking (VR 0 ) for the fulfillment of insurance coverage criteria for functional upper eyelid surgery as compared with standard automated perimetry (SAP). METHODS: This prospective cross-sectional study included 78 eyes from 41 patients with ptosis, brow ptosis, and dermatochalasis undergoing functional upper eyelid surgery evaluation. Participants underwent serial superior visual field tests using SAP and VR 0 or VR-ET in randomized order. Fulfillment of insurance coverage criteria for blepharoplasty was defined as a 30% increase in the grid seen from the untaped to the taped state. The main outcome measure was the sensitivity and specificity of VR 0 , VR-ET, and overall VR in meeting insurance coverage criteria as compared with SAP. RESULTS: VR had a sensitivity of 84.1% and specificity of 67.6%, with no significant difference between VR 0 and VR-ET. SAP agreed on insurance coverage criteria fulfillment with VR 0 in 28 (71.8%) eyes and with VR-ET in 32 (82.1%) eyes. Insurance coverage criteria fulfillment rates varied significantly by diagnosis on SAP ( p = 0.012) but not VR ( p = 0.059). CONCLUSIONS: VR may be an alternative to SAP for functional upper eyelid surgery evaluation. Future studies are needed to determine differences in patient satisfaction, testing and waiting time, and test-retest reliability between VR and SAP.

EZH1 is an antipsychotic-sensitive epigenetic modulator of social and motivational behavior that is dysregulated in schizophrenia.

BACKGROUND: With the capacity to modulate gene networks in an environmentally-sensitive manner, the role of epigenetic systems in mental disorders has come under intense investigation. Dysregulation of epigenetic effectors, including microRNAs and histone-modifying enzymes, may better explain the role of environmental risk factors and the observed heritability rate that cannot be fully attributed to known genetic risk alleles. Here, we aimed to identify novel epigenetic targets of the schizophrenia-associated microRNA 132 (miR-132). METHODS: Histone modifications were quantified by immunodetection in response to viral-mediated overexpression of miR-132 while a luminescent reporter system was used to validate targets of miR-132 in vitro. Genome-wide profiling, quantitative PCR and NanoSting were used to quantify gene expression in post-mortem human brains, neuronal cultures and prefrontal cortex (PFC) of mice chronically exposed to antipsychotics. Following viral-mediated depletion of Enhancer of Zeste 1 (EZH1) in the murine PFC, behaviors including sociability and motivation were assessed using a 3-chambered apparatus and forced-swim test, respectively. RESULTS: Overexpression of miR-132 decreased global histone 3 lysine 27 tri-methylation (H3K27me3), a repressive epigenetic mark. Moreover, the polycomb-associated H3K27 methyltransferase, EZH1, is regulated by miR-132 and upregulated in the PFC of schizophrenics. Unlike its homolog EZH2, expression of EZH1 in the murine PFC decreased following chronic exposure to antipsychotics. Viral-mediated depletion of EZH1 in the mouse PFC attenuated sociability, enhanced motivational behaviors, and affected gene expression pathways related to neurotransmission and behavioral phenotypes. CONCLUSIONS: EZH1 is dysregulated in schizophrenia, sensitive to antipsychotic medications, and a brain-enriched miR-132 target that controls neurobehavioral phenotypes.

Prevalence of Visual Impairment and Availability of Eye Care Providers in Florida.

PURPOSE: To determine the association between prevalence of visual impairment (VI) and density of eye care providers in Florida counties. DESIGN: Cross-sectional study. METHODS: Population-based study included ophthalmologist members of the American Academy of Ophthalmology, licensed optometrists, and respondents of the 2015-2020 American Community Survey (ACS) administered by the US Census Bureau. The number of ophthalmologists collected from the American Academy of Ophthalmology member directory and the number of optometrists collected from the Florida Department of Health License registry were compared with prevalence of VI in each county as reported by ACS 2020 5-year estimates. Median age, mean income, race, and percent uninsured of each county were collected from ACS 2020 5-year estimates. Main outcome measures included the number of eye care providers and prevalence of VI per Florida county. RESULTS: Eye care provider density and mean income of each county were negatively correlated with VI prevalence. Counties with zero eye care providers had significantly higher prevalence of VI per 100 000 residents than those with at least 1 eye care provider. While adjusting for mean income, for every increase in 1 eye care provider per 100 000 people, there was an expected decrease in VI prevalence by 31.15 ± 14.58 people per 100 000 residents. For every increase in mean county income by $1000, there was an expected mean ± SE decrease in prevalence of VI by 24.02 ± 9.90 people per 100 000 people. CONCLUSIONS: Increased eye care provider density and mean county income are associated with lower prevalence of VI in Florida counties. Further studies may elucidate the cause for this relationship and solutions to decrease VI prevalence.

The impact of childhood glaucoma on psychosocial functioning and quality of life: a review of the literature.

We present a novel comprehensive literature review of studies of the psychosocial functioning (PF) and quality of life (QoL) of patients with childhood glaucoma and their caregivers. Our findings demonstrate variable study quality and approach, as well as inconsistent results relating to the association of glaucoma-specific factors and sociodemographic variables with measured PF and QoL. Future studies should focus on the development of culturally cognizant and standardized assessment tools, execution of multi-center longitudinal studies with global representation, evaluation of PF and QoL among siblings and childhood glaucoma providers, and implementation of interventions to improve patient and caregiver PF and QoL.

Professional Quality of Life and Associated Factors Among Pediatric Glaucoma Providers.

PURPOSE: Even though physician burnout can negatively impact physical/mental health, ophthalmologists' quality of life (QOL) is understudied. Although managing high-risk diseases like pediatric glaucoma may lead to compassion satisfaction (CS), the responsibility of caring for very sick, demanding patients has been linked to higher burnout. Burnout and secondary traumatic stress (STS) constitute compassion fatigue, the negative effects resulting from helping those who experience stress. We assessed professional QOL, including CS, burnout, and STS, along with associated factors among pediatric glaucoma providers managing potentially blinding disease in children. DESIGN: Cross-sectional survey study. PARTICIPANTS: Pediatric glaucoma providers in the Childhood Glaucoma Research Network, American Glaucoma Society, and Indian Paediatric Glaucoma Society. METHODS: Participants were sent an electronic survey of a validated instrument (Professional Quality of Life-Version 5) designed to measure burnout, STS, and CS, as well as questions related to demographics, lifestyle, training, and practice. Burnout, STS, and CS scores range from 10 to 50 and are classified into low (≤ 22), moderate (23-41), and high (≥ 42) subgroups. MAIN OUTCOME MEASURES: Burnout, STS, and CS. RESULTS: Seventy-six pediatric glaucoma providers completed the survey with resulting burnout (22.6 ± 6.3), STS (22.7 ± 6.1), and CS (42.3 ± 6.7) scores. Most respondents had low burnout (43, 56.6%), low STS (44, 57.9%) and high CS (48, 63.2%), though more than a third reported moderate burnout (33, 43.4%), STS (31, 40.8%), and CS (27, 35.6%). Older age and more years in practice correlated positively with CS, and age correlated negatively with STS (P < 0.05 for all). Frequent workday fatigue correlated positively with burnout and STS and negatively with CS, and frequent caffeine consumption correlated positively with burnout and negatively with CS (P < 0.05 for all). Members of a married or unmarried couple had significantly lower CS scores than single, divorced, or separated respondents (P = 0.022). CONCLUSIONS: Pediatric glaucoma providers derive a high level of professional satisfaction from their work, though many report moderate burnout and STS. To comprehensively address provider QOL, CS, and both components of compassion fatigue must be considered. Initial efforts may be focused on younger, early-career providers as this group had lower professional QOL scores than their older, late-career counterparts. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Trends in Etiologies, Demographics, and Neuroimaging in New-Onset Adult Strabismus at an Ophthalmic Emergency Department.

PURPOSE: To evaluate new-onset strabismus in adults presenting to an ophthalmic emergency department, and to identify which patients require neuroimaging. METHODS: This was a retrospective review of electronic medical records of patients 18 years and older who presented to an ophthalmic emergency department between January 1, 2019 and December 31, 2020 with new-onset strabismus. Data regarding demographics, causes, neuroimaging, and resolution were recorded and analyzed. RESULTS: Of the 557 patients in the current study, 54.8% were men and the mean age was 57.3 ± 16.7 years (range: 18 to 92 years). Most patients (72.4%) presented with diplopia. Esotropia was the most common ocular misalignment (43.6%) and was more common in women than men (51.6% vs 37.0%, respectively) (P = .001). The most common diagnoses were cranial nerve palsies (66.8%) for both sexes and all age groups, with the most common etiology being microvascular (48.1%) for patients 50 years and older and idiopathic (20.1%) for patients between 18 and 49 years old. The incidence of cranial nerve palsies was significantly higher in older patients (P < .001). Neuroimaging was performed in 58% of patients (n = 323), of whom 37.2% (n = 120) had abnormal findings. The most common abnormal neuroimaging finding was mass for all age groups and sexes (19.2%). Patients with cranial nerve palsy and microvascular etiology had a significantly lower proportion of abnormal neuroimaging findings (P < .001). CONCLUSIONS: Most cases of new-onset strabismus in adults presenting to the emergency department were due to cranial nerve palsy, particularly in older patients. Despite high rates of neuroimaging, patients with cranial nerve palsy had mostly normal findings. The current study supports the belief that neuroimaging may be deferred in patients older than 50 years with micro-vascular risk factors. [J Pediatr Ophthalmol Strabismus. 2022;59(4):269-273.].

Validity of Wait Time Complaints and Effect of Trainee Presence in an Ophthalmic Emergency Department.

PURPOSE: Press Ganey (PG) surveys can provide a more comprehensive evaluation of specific patient complaints through input of comments. In this paper, we evaluate the validity of wait time complaints submitted via PG surveys in an ophthalmic emergency department (ED) and determine the effect of trainee presence on total time spent in the ED and negative PG comments. MATERIALS AND METHODS: This was a retrospective study evaluating PG reports for ED demographic, diagnostic, visit time and trainee involvement trends. RESULTS: Females made up 48.0% (4465) of overall ED patients yet submitted 62.8% (98) of the negative comments on PG surveys. More than a quarter (27.7%) of the negative comments pertained to wait time. Patient-reported times spent in the ED were significantly longer than actual total ED times (p < 0.001). Both reported and actual total ED times were significantly longer for patients who submitted wait time negative comments than those with other complaints (p < 0.001 vs p = 0.039, respectively). Patients seen by residents spent a significantly longer time in the ED than those seen by non-resident providers (p = 0.015), although self-reported total ED times did not differ significantly in these patients (p = 0.467). CONCLUSION: Patients submitting complaints about wait time and those seen by treatment teams including residents spent a significantly longer time in the ED. Although PG survey respondents are not representative of the overall ED patient population, this highlights the need for academic institutions to seek methods to maximize efficiency in patient care without compromising trainee education.

Placement and Extension of Glaucoma Drainage Devices Using Polypropylene Suture in Pediatric Patients.

Glaucoma drainage device tube placement and extension in pediatric patients may be complicated by abnormal anterior segment anatomy and corneal opacities. The authors describe two techniques for placement and extension of non-valved glaucoma drainage device tubes using polypropylene suture as a guidewire and stabilizer, respectively. [J Pediatr Ophthalmol Strabismus. 2022;59(5):e62-e65.].

A Novel Technique for Anterior Segment Imaging Using B-scan Ultrasonography When Ultrasound Biomicroscopy Is Unavailable.

Ultrasound biomicroscopy offers high-resolution images of anterior segment anatomy, essential for determining surgical intervention in special circumstances, yet is sometimes unavailable. The authors describe a novel technique to obtain gross anterior segment visualization using a commonly available instrument, B-scan ultrasonography, and compare it to ultrasound biomicroscopy imaging from two pediatric cases. [J Pediatr Ophthalmol Strabismus. 2022;59(5):e58-e61.].

Evaluation of Port Delivery System with ranibizumab for the treatment of neovascular age-related macular degeneration.

Current treatment of neovascular age-related macular degeneration involves periodic intravitreal injections of anti-VEGF medication, creating a burden to patients and physicians, resulting in nonadherence to recommended dosing schedules. The Port Delivery System with ranibizumab offers a long-term solution that involves implantation of a device into the pars plana and provides continuous release of anti-VEGF medication into the vitreous, thus requiring fewer office visits. The Port Delivery System has demonstrated comparable visual and anatomic outcomes to monthly injections and shows promise in alleviating the patient burden in the treatment of neovascular age-related macular degeneration, making possible better long-term real-world visual outcomes.

Evaluation of the Content, Quality, and Readability of Patient Accessible Online Resources Regarding Cataracts.

PURPOSE: To evaluate the content quality, accuracy, and readability of commonly visited websites by cataract patients contemplating cataract surgery. SETTING: Freely available online information. DESIGN: Cross-sectional study. METHODS: Ten websites were evaluated in a cross-sectional study for content analysis using a grading sheet of 40 questions individually scored by three ophthalmologists. JAMA benchmarks were used to assess the quality. An online readability tool, Readable, was used to assess the readability. RESULTS: There was a significant difference between the content and accuracy of each website according to a Kruskal-Wallis test (H = 22.623, P = .007). The average score for all websites using the grading sheet was 90.85 out of 160 points, or 57% (SD 29.93, CI 95%±17.69). There was no significant correlation between website rank on Google.com and content quality of the website (r = 0.049, P = .894). No websites complied with all 4 JAMA criteria for authorship. There was no significant correlation between content quality of each website and number of JAMA requirements met (r = -0.563, P = .09). The average Flesch Reading Ease Score for all websites was 52.64 (SD 11.94, CI 95%±7.40), and the average Mean Reading Grade was 10.72 (SD 1.58, CI 95%±0.98). There was a significant difference in Mean Reading Grades between websites (H = 23.703, P = .005). There was no significant correlation between content quality of the website and Mean Reading Grade (r = -0.552, P = .098). CONCLUSION: Commonly accessed online resources on cataracts and cataract surgery are insufficient to provide patients with a clear and complete understanding of their condition as well as available medical and surgical treatment options.