1
|
Viberg A, Bro T, Behndig A, Kugelberg M, Zetterberg M, Nilsson I, Lundström M. Ten-year trends of delayed sequential bilateral cataract surgery (DSBCS) in Sweden: a register-based study. EYE AND VISION (LONDON, ENGLAND) 2024; 11:39. [PMID: 39350282 PMCID: PMC11443835 DOI: 10.1186/s40662-024-00406-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 09/04/2024] [Indexed: 10/04/2024]
Abstract
PURPOSE To study the trend of delayed sequential bilateral cataract surgery (DSBCS) in Sweden in the past decade. METHODS This register-based cohort study utilized data from the Swedish National Cataract Register (NCR) from 2010 through 2019. Register files from patients who underwent cataract surgery in both eyes during the study period were linked using their social security numbers. Bilateral surgeries on different days were classified as DSBCS. The study investigated the association between DSBCS within 3 months and several variables with stratification and multivariate logistic regression. The following variables were used: operation year, region, private or public unit, age, sex, indication for surgery, type of intraocular lens (IOL), preoperative visual acuity, ocular comorbidity, posterior capsule rupture and perioperative difficulties. RESULTS During the study period, 368,106 patients underwent DSBCS, of which 62.6% (n = 230,331) had bilateral surgery within 3 months. The median time between the surgeries was 61 days (interquartile range 26-161 days), showing regional variations. Better visual acuity in the fellow eye, presence of ocular comorbidity, various perioperative events and complications were associated with longer time to surgery of the second eye. Conversely, cataract surgery in more recent years, private clinic, increasing age, anisometropia and multifocal IOL were associated with shorter timespan between surgeries. CONCLUSIONS The majority of DSBCS were conducted within a 3-month timeframe, with the interval between surgeries decreasing throughout the study period. Several rational factors were associated with the time difference, in addition to regional variations. Many patients would probably benefit from less time between the surgeries, and we encourage a clinical practice taking the whole patient's visual function into account.
Collapse
Affiliation(s)
- Andreas Viberg
- Department of Clinical Sciences, Ophthalmology, Umeå University, 901 85, Umeå, Sweden.
| | - Tomas Bro
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anders Behndig
- Department of Clinical Sciences, Ophthalmology, Umeå University, 901 85, Umeå, Sweden
| | - Maria Kugelberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Madeleine Zetterberg
- Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden
| | | | - Mats Lundström
- Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
| |
Collapse
|
2
|
Ross C, Ghauri S, Gilbert JB, Hu D, Ullanat V, Gong D, Greenberg PB, Eliott D, Elze T, Lorch A, Miller JW, Krzystolik MG. Intravitreal Antibiotics versus Early Vitrectomy plus Intravitreal Antibiotics for Post-Injection Endophthalmitis: an IRIS® Registry (Intelligent Research in Sight). Ophthalmol Retina 2024:S2468-6530(24)00424-X. [PMID: 39260568 DOI: 10.1016/j.oret.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 08/22/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024]
Abstract
PURPOSE To determine if intravitreal injection of antibiotics alone versus early pars plana vitrectomy (PPV) plus injection of intravitreal antibiotics predicted better or worse visual outcomes for patients with endophthalmitis after anti-vascular endothelial growth factor (anti-VEGF) injections. DESIGN Retrospective cohort study PARTICIPANTS: Patients developing endophthalmitis after receiving an intravitreal anti-VEGF injection from the American Academy of Ophthalmology IRIS® Registry between 2016 and 2020. METHODS Inclusion criteria were endophthalmitis diagnosis within 1 to 28 days after anti-VEGF injection and a recorded visual acuity (VA) at baseline, on the day of diagnosis, and post-treatment. Patients in the Injection Only group underwent intravitreal injection of antibiotics alone and in the Early Vitrectomy group received PPV with intravitreal antibiotics or intravitreal injection followed by PPV within 2 days of diagnosis. Patients were excluded if they had cataract surgery during the study, intravitreal steroids before endophthalmitis, or intermediate/posterior uveitis or cystoid macular edema. The study created a 1:1 matched cohort using Mahalanobis Distance Matching, accounting for the differences in VA at baseline and diagnosis. MAIN OUTCOME MEASURES Post-treatment logMAR VA RESULTS: 1,044 patients diagnosed with post-injection endophthalmitis met the inclusion and exclusion criteria. In the unmatched cohort, there were 935 patients in the Injection Only and 109 in the Early Vitrectomy group. In 1:1 matched cohort 218 patients (109 in each group) were included; the median logMAR VAs were 0.32 [20/40-20/50] at baseline, 0.88 [∼20/150] at diagnosis, and 0.57 [20/70-20/80] post-treatment. There were no statistically significant differences in the visual outcomes between the two matched treatment groups (b = 0.05, p = 0.23); including the subgroup of patients with VA worse than 1.0 logMAR (b = 0.05, p = 0.452). CONCLUSIONS There was no significant difference in final VA outcomes between patients receiving Injection Only and those treated with Early Vitrectomy for post-injection endophthalmitis. The findings support the use of either treatment strategy.
Collapse
Affiliation(s)
- Connor Ross
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MassachusettsUSA
| | - Sophia Ghauri
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MassachusettsUSA; Division of Ophthalmology, Warren Alpert Medical School, Brown University, Providence, Rhode Island USA
| | - Joshua B Gilbert
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MassachusettsUSA
| | - Daniel Hu
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MassachusettsUSA; Division of Ophthalmology, Warren Alpert Medical School, Brown University, Providence, Rhode Island USA
| | - Varun Ullanat
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MassachusettsUSA
| | - Dan Gong
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MassachusettsUSA
| | - Paul B Greenberg
- Division of Ophthalmology, Warren Alpert Medical School, Brown University, Providence, Rhode Island USA
| | - Dean Eliott
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MassachusettsUSA
| | - Tobias Elze
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MassachusettsUSA
| | - Alice Lorch
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MassachusettsUSA
| | - Joan W Miller
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MassachusettsUSA
| | - Magdalena G Krzystolik
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MassachusettsUSA
| |
Collapse
|
3
|
Tavolato M, Modugno R, Giglio R, Inferrera L, Tognetto D. Immediate sequential bilateral cataract surgery: Prevalence, attitudes and concerns Among Italian ophthalmologists. Eur J Ophthalmol 2024:11206721241272156. [PMID: 39105233 DOI: 10.1177/11206721241272156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
PURPOSE to investigate the existing practice patterns of immediate sequential bilateral cataract surgery (ISBCS) in Italy and to assess ophthalmologists' attitudes towards performing ISBCS in the future for cataract treatment. METHODS It is a multicenter cross-sectional study. From February,1st 2023 to March, 1st 2023 the Members of the Italian Society of Cataract and Refractive Surgery (AICCER) as well as the attendees of its annual national congress were invited to anonymously complete an electronic 7-item questionnaire on their current ICBCS practice. Questions included the average number of procedures per month, the main indications for ICBCS, and the main reasons for performing and not performing ISBCS. Data were analyzed using descriptive statistics. RESULTS of the 2300 recipients, 246 (10.7%) completed the survey. Of the respondents, 156 (63.4%) replied to perform ISBCS, most of them (82%) occasionally (1 to 5 procedures per month). Fifty-three percent (130 ophthalmologists) considered adopting ISBCS as routine practice in the near future. The conditions most considered for ISBCS were age-related cataract surgery under general and topical anesthesia and congenital cataract surgery. The availability of separate instruments for the two eyes as well as patient and hospital advantages were the most important reasons for performing ISBCS. The risk of bilateral endophthalmitis and medicolegal issues were the main reasons for not performing ISBCS. CONCLUSIONS ISBCS remains controversial among Italian surgeons, despite growing evidence of its safety and efficacy. The risk of potentially blinding complications such as bilateral endophthalmitis, together with medicolegal concerns are the principal barriers to ISBCS implementation in routine practice.
Collapse
Affiliation(s)
- Marco Tavolato
- Ophthalmology Unit, Camposampiero Hospital, Padova, Italy
| | - Rocco Modugno
- Ophthalmology Unit, Camposampiero Hospital, Padova, Italy
| | - Rosa Giglio
- Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Leandro Inferrera
- Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| | - Daniele Tognetto
- Department of Medical, Surgical Sciences and Health, University of Trieste, Trieste, Italy
| |
Collapse
|
4
|
Lidder AK, Vanner EA, Chang TC, Lum F, Rothman AL. Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS® Registry (Intelligent Research in Sight). Ophthalmology 2024; 131:780-789. [PMID: 38246424 DOI: 10.1016/j.ophtha.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
PURPOSE To evaluate risk factors for intraocular pressure (IOP) spike after cataract surgery using the IRIS® Registry (Intelligent Research in Sight). DESIGN Retrospective clinical cohort study. PARTICIPANTS Adults with IRIS Registry data who underwent stand-alone phacoemulsification from January 1, 2013, through September 30, 2019. METHODS Intraocular pressure spike was defined as postoperative IOP of > 30 mmHg and > 10 mmHg from the baseline within the first postoperative week. Odds ratios (ORs) for demographic and clinical characteristics were calculated with univariable and multivariable logistic regression analyses. MAIN OUTCOME MEASURES Incidence and OR of IOP spike. RESULTS We analyzed data from 1 191 034 eyes (patient mean age, 71.3 years; 61.2% female sex; and 24.8% with glaucoma). An IOP spike occurred in 3.7% of all eyes, 5.2% of eyes with glaucoma, and 3.2% of eyes without glaucoma (P < 0.0001). Multivariable analyses of all eyes indicated a greater risk of IOP spike with higher baseline IOP (OR, 1.57 per 3 mmHg), male sex (OR, 1.79), glaucoma (OR, 1.20), Black race (OR, 1.39 vs. Asian and 1.21 vs. Hispanic), older age (OR, 1.07 per 10 years), and complex surgery coding (OR, 1.22; all P < 0.0001). Diabetes (OR, 0.90) and aphakia after surgery (OR, 0.60) seemed to be protective against IOP spike (both P < 0.0001). Compared with glaucoma suspects, ocular hypertension (OR, 1.55), pigmentary glaucoma (OR, 1.56), and pseudoexfoliative glaucoma (OR, 1.52) showed a greater risk of IOP spike and normal-tension glaucoma (OR, 0.55), suspected primary angle closure (PAC; OR, 0.67), and PAC glaucoma (OR, 0.81) showed less risk (all P < 0.0001). Using more baseline glaucoma medications was associated with IOP spike (OR, 1.18 per medication), whereas topical β-blocker use (OR, 0.68) was protective (both P < 0.0001). CONCLUSIONS Higher baseline IOP, male sex, glaucoma, Black race, older age, and complex cataract coding were associated with early postoperative IOP spike, whereas diabetes and postoperative aphakia were protective against a spike after stand-alone phacoemulsification. Glaucomatous eyes demonstrated different risk profiles dependent on glaucoma subtype. The findings may help surgeons to stratify and mitigate the risk of IOP spike after cataract surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Alcina K Lidder
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida; Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth A Vanner
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Ta Chen Chang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Adam L Rothman
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
| |
Collapse
|
5
|
Stein JD, Zhou Y, Andrews CA, Kim JE, Addis V, Bixler J, Grove N, McMillan B, Munir SZ, Pershing S, Schultz JS, Stagg BC, Wang SY, Woreta F. Using Natural Language Processing to Identify Different Lens Pathology in Electronic Health Records. Am J Ophthalmol 2024; 262:153-160. [PMID: 38296152 PMCID: PMC11098689 DOI: 10.1016/j.ajo.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/21/2024] [Accepted: 01/22/2024] [Indexed: 05/18/2024]
Abstract
PURPOSE Nearly all published ophthalmology-related Big Data studies rely exclusively on International Classification of Diseases (ICD) billing codes to identify patients with particular ocular conditions. However, inaccurate or nonspecific codes may be used. We assessed whether natural language processing (NLP), as an alternative approach, could more accurately identify lens pathology. DESIGN Database study comparing the accuracy of NLP versus ICD billing codes to properly identify lens pathology. METHODS We developed an NLP algorithm capable of searching free-text lens exam data in the electronic health record (EHR) to identify the type(s) of cataract present, cataract density, presence of intraocular lenses, and other lens pathology. We applied our algorithm to 17.5 million lens exam records in the Sight Outcomes Research Collaborative (SOURCE) repository. We selected 4314 unique lens-exam entries and asked 11 clinicians to assess whether all pathology present in the entries had been correctly identified in the NLP algorithm output. The algorithm's sensitivity at accurately identifying lens pathology was compared with that of the ICD codes. RESULTS The NLP algorithm correctly identified all lens pathology present in 4104 of the 4314 lens-exam entries (95.1%). For less common lens pathology, algorithm findings were corroborated by reviewing clinicians for 100% of mentions of pseudoexfoliation material and 99.7% for phimosis, subluxation, and synechia. Sensitivity at identifying lens pathology was better for NLP (0.98 [0.96-0.99] than for billing codes (0.49 [0.46-0.53]). CONCLUSIONS Our NLP algorithm identifies and classifies lens abnormalities routinely documented by eye-care professionals with high accuracy. Such algorithms will help researchers to properly identify and classify ocular pathology, broadening the scope of feasible research using real-world data.
Collapse
Affiliation(s)
- Joshua D Stein
- From the W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA (J.D.S., Y.Z., C.A.A., J.B.); Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA (J.D.S.).
| | - Yunshu Zhou
- From the W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA (J.D.S., Y.Z., C.A.A., J.B.)
| | - Chris A Andrews
- From the W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA (J.D.S., Y.Z., C.A.A., J.B.)
| | - Judy E Kim
- Department of Ophthalmology and Visual Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA (J.E.K.)
| | - Victoria Addis
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA (V.A.)
| | - Jill Bixler
- From the W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan, USA (J.D.S., Y.Z., C.A.A., J.B.)
| | - Nathan Grove
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado, USA (N.G.)
| | - Brian McMillan
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, West Virginia, USA (B.M.)
| | - Saleha Z Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA (S.Z.M.)
| | - Suzann Pershing
- Byers Eye Institute at Stanford, Department of Ophthalmology, Stanford University, Stanford, California, USA (S.P., S.Y.W.); VA Palo Alto Health Care System, Palo Alto, California, USA (S.P.)
| | - Jeffrey S Schultz
- Department of Ophthalmology, Montefiore Medical Center, New York, New York, USA (J.S.S.)
| | - Brian C Stagg
- Department of Ophthalmology, University of Utah, Salt Lake City, Utah, USA (B.C.S.)
| | - Sophia Y Wang
- Byers Eye Institute at Stanford, Department of Ophthalmology, Stanford University, Stanford, California, USA (S.P., S.Y.W.)
| | - Fasika Woreta
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA (F.W.)
| |
Collapse
|
6
|
You E, Hébert M, Arsenault R, Légaré MÈ, Mercier M. Perception of Canadian ophthalmologists on immediately sequential bilateral cataract surgery: insights and implications. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:146-153. [PMID: 37290485 DOI: 10.1016/j.jcjo.2023.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate the perception of immediately sequential bilateral cataract surgery (ISBCS) among Canadian ophthalmologists. DESIGN An anonymous survey was sent to all active members of the Canadian Ophthalmological Society. METHODS Basic demographic information, cataract surgery practice patterns, and perceived advantages, disadvantages, and concerns regarding ISBCS were collected from respondents. RESULTS A total of 352 ophthalmologists answered the survey. Among these, 94 respondents (27%) practice ISBCS routinely, 123 (35%) practice ISBCS in exceptional cases, and 131 (37%) do not practice ISBCS. ISBCS practitioners were significantly younger than nonpractitioners (p < 0.001) and had a shorter duration of practice (p < 0.001). The prevalence of ISBCS practitioners also varied significantly by province (p < 0.001): most practitioners who routinely practice ISBCS were from Quebec (n = 44; 48%), where financial disincentives are lowest in the country. The main work setting of ISBCS practitioners was academic centres (n = 39; 42%) as opposed to private or community settings (p < 0.001). The main reason for performing ISBCS was more efficient operating theatre use (n = 142; 65%). The main concerns regarding ISBCS were the risk of bilateral complications (n = 193; 57%) and the lack of refractive outcomes for second-eye surgery (n = 184; 52%). The COVID-19 pandemic positively influenced the view of 152 respondents (43%), but this was mostly among practitioners who already performed ISBCS routinely (n = 77; 84%). CONCLUSIONS ISBCS practitioners are more likely younger ophthalmologists working in academic centres. Quebec has the highest prevalence of ISBCS practitioners. ISBCS practitioners were positively influenced by the COVID-19 pandemic to offer ISBCS more often compared with non-ISBCS practitioners.
Collapse
Affiliation(s)
- Eunice You
- Department of Ophthalmology, Blessed Sacrament Hospital, University Hospital Centre (CHU) of Quebec-Laval University, Quebec, QC
| | - Mélanie Hébert
- Department of Ophthalmology, Blessed Sacrament Hospital, University Hospital Centre (CHU) of Quebec-Laval University, Quebec, QC
| | | | - Marie-Ève Légaré
- Department of Ophthalmology, Blessed Sacrament Hospital, University Hospital Centre (CHU) of Quebec-Laval University, Quebec, QC; Faculty of Medicine, Laval University, Quebec, QC
| | - Mathieu Mercier
- Department of Ophthalmology, Blessed Sacrament Hospital, University Hospital Centre (CHU) of Quebec-Laval University, Quebec, QC; Faculty of Medicine, Laval University, Quebec, QC..
| |
Collapse
|
7
|
Jiang Y, Chen X, Cheng M, Li B, Lei Y, Lin IC, Xu G, Mingwei L, Zhou X, Wang X. Immediate versus delayed sequential bilateral ICL implantation: A retrospective comparison of vault height and visual outcomes. Asia Pac J Ophthalmol (Phila) 2024:100075. [PMID: 38795866 DOI: 10.1016/j.apjo.2024.100075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 05/28/2024] Open
Abstract
PURPOSE To compare the visual outcomes and risks of suboptimal vault-related complications between immediate sequential bilateral ICL surgery (ISBICLS) and delayed sequential bilateral ICL surgery (DSBICLS). DESIGN A retrospective cohort study. METHODS Patients who underwent bilateral ICL implantation between November 2014 and December 2021 at the Eye and ENT Hospital of Fudan University (Shanghai, China) were included and divided into two groups: (1) ISBICLS: both eye surgeries performed on the same day, and (2) DSBICLS: second eye surgery performed < 7 days following the first one. Propensity score matching (PSM) was performed to compare the visual outcomes. Multivariable logistic regression models were used to estimate the odds ratios (ORs) of the suboptimal vaults. RESULTS Finally, 10,985 eyes were included. After PSM, 204 first surgery eyes and 162 s surgery eyes with complete postoperative data were matched. The safety and efficacy indices did not statistically differ between groups (all > 1.00), except that ISBICLS first surgery eyes achieved better efficacy index than DSBICLS group (1.03 ± 0.26 vs. 1.08 ± 0.23, P = 0.034). Excessive vault was observed in eight (4.06 %) ISBICLS first eyes, one (0.50 %) DSBICLS first eye, and none in the second surgery eye in either group. An insufficient vault was observed in one second eye and one DSBICLS second eye. We found no evidence of differences in the rate of excessive vault (OR = 0.831, 95 % CI: 0.426-1.622, P = 0.588) or insufficient vault (OR = 0.609, 95 % CI:0.062-5.850, P = 0.668). CONCLUSION ISBICLS provided safety, efficacy, and refraction predictability comparable to DSBICLS without increasing the risk of suboptimal vault-related complications.
Collapse
Affiliation(s)
- Yinjie Jiang
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Xun Chen
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Mingrui Cheng
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Boliang Li
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Yadi Lei
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - I-Chun Lin
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Guanghan Xu
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Li Mingwei
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Xingtao Zhou
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences
| | - Xiaoying Wang
- Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, National Health Commision, Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China; Key laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences.
| |
Collapse
|
8
|
Russo A, Filini O, Mertens E, Daya SM, Conti L, Carones F, Festa G, Boldini A, Savini G. Immediate Sequential Bilateral Implantable Collamer Lens Surgery Is Safe and Effective. J Refract Surg 2024; 40:e313-e320. [PMID: 38717079 DOI: 10.3928/1081597x-20240326-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2024]
Abstract
PURPOSE To assess the clinical outcomes and safety profiles of patients who underwent immediate sequential bilateral phakic lens surgery. METHODS This retrospective multicenter study included 254 consecutive patients (508 eyes) who underwent bilateral same-day Implantable Collamer Lens (ICL) (STAAR Surgical) surgery. The authors focused on 1-year postoperative clinical outcomes and adverse events. RESULTS In the initial cohort, 176 patients (352 eyes) met inclusion criteria. Of these, 335 eyes underwent myopic ICL placement, and 17 eyes received a hyperopic ICL. Notably, 87% of eyes achieved ±0.50 diopters (D) and 95% achieved ±1.00 D of the intended refraction. One year postoperatively, 78% of eyes demonstrated optimal vaulting (250 to 750 µm), with a significant 19% reduction in vaulting observed over the 12 months (P < .001). Only minor adverse events, including early cataract formation (1 case), secondary toric ICL rotation (3 cases), and ICL exchange due to inappropriate vaulting (6 cases), were noted. CONCLUSIONS The findings corroborate the safety and efficacy of immediate sequential bilateral phakic lens surgery and indicate its potential as a treatment option. The low incidence of minor adverse events further reinforces its favorable safety profile. [J Refract Surg. 2024;40(5):e313-e320.].
Collapse
|
9
|
Lorger A, Luft N, Mayer WJ, Priglinger SG, Dirisamer M. One-stage versus two-stage bilateral implantable collamer lens implantation: a comparison of efficacy and safety. Sci Rep 2024; 14:5648. [PMID: 38453996 PMCID: PMC10920801 DOI: 10.1038/s41598-024-54101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/08/2024] [Indexed: 03/09/2024] Open
Abstract
Implantable collamer lens implantation (ICL) represents a safe and effective treatment for myopia and myopic astigmatism. To compare the outcomes of a bilateral one-stage same day approach to a two-stage approach, the databases of the University Eye Hospital Munich, Ludwig Maximilians-University and Smile Eyes Linz, Austria were screened for eyes that had undergone ICL implantation. Two-stage surgery was performed at an interval of 1 day (17 patients), 2 days (19 patients) and 1 week (2 patients). Variables analyzed were preoperative, 1-day and last follow-up uncorrected distance (UDVA) and corrected distance visual acuity (CDVA), manifest refraction, refractive spherical equivalent (SEQ), astigmatism, age, endothelial cell count (ECD), intraocular pressure (IOP) and ICL vaulting. In total, 178 eyes (100 eyes one-stage, 78 eyes two-stage) of 89 patients were included in this study. Mean follow-up was 1.1 ± 0.8 and 1.3 ± 0.5 years. Mean preoperative SEQ was - 7.9 ± 2.6 diopters (D) in the one-stage and - 8.0 ± 1.7 D in the two-stage group (p = 0.63) and improved to 0.00 ± 0.40 and - 0.20 ± 0.40 D at end of follow-up, showing slightly better stability in the one-stage group (p = 0.004). There was no difference in the efficacy (1.1 vs. 1.2, p = 0.06) and the safety index (1.2 vs. 1.2, p = 0.60) between the two groups. No eye (0%) in either group lost 2 lines or more of UDVA (p > 0.99). Refraction within ± 0.50 D and ± 1.00 D around target was achieved comparably often (89 vs. 86%, p = 0.65; 99 vs. 99%, p > 0.99). Endothelial cell loss was slightly higher in the two-stage group (1.3 vs. 4.3%). Vaulting at the final follow up was higher in the one-stage group (373.8 ± 205.4 µm vs. 260.3 ± 153.5 µm, p = 0.00007). There were no serious intraoperative complications in either group. In conclusion, this study demonstrates that both the one- and two-stage approaches are equally effective, predictable and safe. Regarding endothelial cell loss, vaulting and SEQ stability, the one-stage group showed slightly better outcomes, but these results are clinically questionable because they are so small. Larger studies are needed to quantitatively evaluate a potential benefit.
Collapse
Affiliation(s)
- Anna Lorger
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstrasse 8, 80336, Munich, Germany
| | - Nikolaus Luft
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstrasse 8, 80336, Munich, Germany
- SMILE Eyes Linz, Linz, Austria
| | - Wolfgang J Mayer
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstrasse 8, 80336, Munich, Germany
| | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstrasse 8, 80336, Munich, Germany
- SMILE Eyes Linz, Linz, Austria
| | - Martin Dirisamer
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Mathildenstrasse 8, 80336, Munich, Germany.
- SMILE Eyes Linz, Linz, Austria.
| |
Collapse
|
10
|
Garcia O’Farrill N, Abi Karam M, Villegas VM, Flynn HW, Grzybowski A, Schwartz SG. New Approaches to Overcoming Antimicrobial Resistance in Endophthalmitis. Pharmaceuticals (Basel) 2024; 17:321. [PMID: 38543107 PMCID: PMC10974156 DOI: 10.3390/ph17030321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/01/2024] Open
Abstract
Endophthalmitis is a rare but vision-threatening infection characterized by marked inflammation of intraocular fluids and tissues, uncommonly seen following surgery and intravitreal injection. Antimicrobials are used worldwide in the prophylaxis and treatment of bacterial and fungal infections of the eye and are standard treatment in the preoperative and postoperative care of surgical patients. However, antimicrobials are reported to be overprescribed in many parts of the world, which contributes to antimicrobial resistance (AMR). AMR complicates the prophylaxis and treatment of endophthalmitis. This article examines the prevalence and mechanisms of AMR in ocular microorganisms, emphasizing the importance of understanding AMR patterns for tailored treatments. It also explores prophylaxis and management strategies for endophthalmitis, with a discussion on the use of intracameral antibiotic administration. The use of prophylactic intracameral antibiotics during cataract surgery is common in many parts of the world but is still controversial in some locations, especially in the US. Finally, it highlights the role of stewardship in ophthalmology and its benefits in the treatment of endophthalmitis.
Collapse
Affiliation(s)
- Noraliz Garcia O’Farrill
- Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA; (N.G.O.); (V.M.V.)
| | - Mariana Abi Karam
- Department of Ophthalmology, MetroHealth, Cleveland, OH 44109, USA;
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Victor M. Villegas
- Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA; (N.G.O.); (V.M.V.)
| | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61-553 Poznan, Poland;
| | - Stephen G. Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| |
Collapse
|
11
|
Sabharwal J, Dai X, Dun C, Chen A, Ali M, Schein OD, Ramulu PY, Makary M, Johnson TV, Woreta F. Early Endophthalmitis Incidence and Risk Factors after Glaucoma Surgery in the Medicare Population from 2016 to 2019. Ophthalmology 2024; 131:179-187. [PMID: 37709170 DOI: 10.1016/j.ophtha.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
PURPOSE To determine early endophthalmitis incidence and risk factors after glaucoma surgeries in the Medicare population. DESIGN Retrospective, longitudinal study. PARTICIPANTS Medicare Fee-for-Service (FFS) and Medicare Advantage beneficiaries in the United States aged 65 years or older undergoing glaucoma surgery. METHODS Medicare claims were used to identify all patients who underwent glaucoma, cataract, or combined cataract/glaucoma surgery from 2016 to 2019. Endophthalmitis cases within 42 days of the index surgery were identified using the diagnostic codes. Multivariable logistic regression models were used to evaluate factors associated with postoperative endophthalmitis. MAIN OUTCOME MEASURES The 42-day postoperative endophthalmitis incidence and risk factors associated with endophthalmitis after glaucoma surgery. RESULTS There were 466 928 glaucoma surgeries, of which 310 823 (66.6%) were combined with cataract surgery. Cataract surgeries alone (n = 8 460 360) served as a reference group. Microinvasive glaucoma surgeries constituted most glaucoma procedures performed (67.8%), followed by trabeculectomy (14.0%), tube shunt (10.9%), and other procedures (7.3%). There were 572 cases of endophthalmitis identified after all glaucoma surgeries. Endophthalmitis incidence after glaucoma, combined cataract/glaucoma, and cataract surgeries alone was 1.5 (95% confidence interval [CI], 1.3-1.7), 1.1 (95% CI, 1.0-1.2), and 0.8 (95% CI, 0.8-0.8) per 1000 procedures, respectively. The median day of diagnosis of endophthalmitis was later for glaucoma surgeries (16.5 days) compared with combined cataract/glaucoma or cataract surgeries alone (8 and 6 days, respectively). Compared with microinvasive glaucoma surgery (MIGS), tube shunts were the only surgery type to be a significant risk factor for endophthalmitis for both stand-alone (adjusted odds ratio [aOR], 1.8, P = 0.002) and combined surgery (aOR 1.8, P = 0.047). The other risk factor for both stand-alone (aOR 1.1, P = 0.001) and combined (aOR 1.06, P = 0.049) surgeries was the Charlson Comorbidity Index (CCI). Age (aOR 1.03, P = 0.004) and male gender (1.46, P = 0.001) were significant risk factors for combined cataract and glaucoma surgeries. CONCLUSIONS Compared with cataract surgery, early endophthalmitis incidence was higher for both glaucoma and combined cataract/glaucoma surgeries, with the highest incidence among tube shunts. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Jasdeep Sabharwal
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Xi Dai
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ariel Chen
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Muhammad Ali
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oliver D Schein
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pradeep Y Ramulu
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Biomedical Informatics and Data Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas V Johnson
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| |
Collapse
|
12
|
Chen A, Dun C, Schein OD, Srikumaran D, Zafar S, Makary M, Woreta F. Endophthalmitis rates and risk factors following intraocular surgeries in the medicare population from 2016 to 2019. Br J Ophthalmol 2024; 108:232-237. [PMID: 37734768 DOI: 10.1136/bjo-2023-323865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/02/2023] [Indexed: 09/23/2023]
Abstract
AIMS To determine endophthalmitis rates and risk factors following intraocular surgeries in the Medicare population. METHODS Retrospective, cross-sectional study from 2016 to 2019 in Medicare fee-for-service and Medicare Advantage beneficiaries. 100% Medicare claims were used to identify eyes that underwent intraocular surgery. Exclusion criteria included eyes that had intraocular surgery 42 days before or after and eyes in patients with a history of endophthalmitis within 12 months. RESULTS 9 744 400 intraocular surgeries were performed among Medicare beneficiaries from 2016 to 2019. A 42-day postoperative endophthalmitis rate was 0.09%. Endophthalmitis rate by surgery type was 0.43% for corneal transplant, 0.36% for secondary intraocular lens (IOL), 0.24% for retina, 0.16% for glaucoma, 0.11% for cataract combined with other procedures and 0.08% for cataract surgeries alone. On multivariable analysis, the risk of endophthalmitis was increased for all intraocular surgery types when compared with cataract surgeries; adjusted OR (aOR) 5.30 (p<0.01) for corneal transplant, aOR 4.50 (p<0.01) for secondary IOL, aOR 3.00 (p<0.01) for retina, aOR 1.93 (p<0.01) for glaucoma, aOR 1.45 (p<0.01) for combined cataract surgeries. Increased risk of developing endophthalmitis was associated with older age (≥85 vs 65-75 years: aOR 1.36; p<0.01), male sex (aOR 1.20; p<0.001) and greater Charlson Comorbidity Index (≥7 vs 0: aOR 1.79; p<0.01). CONCLUSIONS Postoperative endophthalmitis rate after intraocular surgeries was 0.09% between 2016 and 2019 for Medicare beneficiaries. Endophthalmitis rates were highest for corneal transplant surgeries followed by secondary IOL surgeries and lowest for cataract surgeries. Older age, male gender and higher comorbidity index were associated with risk of endophthalmitis.
Collapse
Affiliation(s)
- Ariel Chen
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oliver D Schein
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Martin Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| |
Collapse
|
13
|
Lam L, Bradbrook D, Gale J. Tracing the barriers to decarbonising ophthalmology: A review. Clin Exp Ophthalmol 2024; 52:78-90. [PMID: 38213078 DOI: 10.1111/ceo.14349] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
As climate change demands increasingly urgent mitigation of greenhouse gas emissions, the health sector needs to do its part to decarbonise. Ophthalmologists share concerns about climate change and seek opportunities to reduce their environmental impact. When measuring the footprint of ophthalmology, major contributions are from patient travel to clinics, and from the large amounts of single-use disposable materials that are consumed during surgeries and sterile procedures. Ophthalmic services in India have already demonstrated systems that consume far fewer of these products through efficient throughput of patients and the safe reuse of many items, while maintaining equivalent safety and quality outcomes. Choosing these low-cost low-emission options would seem obvious, but many ophthalmologists experience barriers that prevent them operating as Indian surgeons do. Understanding these barriers to change is a crucial step in the decarbonisation of ophthalmology and the health sector more broadly.
Collapse
Affiliation(s)
- Lydia Lam
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Darren Bradbrook
- Surgery and Perioperative Medicine Division, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Southern Adelaide Local Health Network (SALHN), Bedford Park, South Australia, Australia
| | - Jesse Gale
- Department of Surgery & Anaesthesia, University of Otago Wellington, Wellington, New Zealand
- Ophthalmology, Te Whatu Ora Health New Zealand Capital Coast & Hutt Valley, Wellington, New Zealand
| |
Collapse
|
14
|
Nowrouzi A, Alió JL. Immediately sequential bilateral cataract surgery. Curr Opin Ophthalmol 2024; 35:17-22. [PMID: 38390776 DOI: 10.1097/icu.0000000000001003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
PURPOSE OF REVIEW This review aims to clarify the advantages and disadvantages of immediately sequential bilateral cataract surgery (ISBCS) based on recent studies, illustrate the safety of this approach, the cost-effectiveness, and present the importance of inclusion protocols for the best results. RECENT FINDINGS In recent studies, the authors found no evidence of an increased risk of bilateral devastating complications such as endophthalmitis with ISBCS based on descriptive evidence compared to delayed sequential bilateral cataract surgery (DSBCS). Furthermore, recent studies on cost analyses showed that ISBCS resulted in fewer costs and significant cost savings to third-party payers, patients, and society compared to DSBCS. SUMMARY The ISBCS surgical approach decreases hospital visits, reduces costs, and provides rapid visual rehabilitation and neuro adaptation. The risk of bilateral simultaneous complications is now recognized to be very rare with intracameral antibiotics and compliance with correct protocols. With new generations of optical biometry and lens calculation formulas, refractive surprises are occasional for normal eyes. However, refractive surprise is controversial, especially in the implantation of presbyopia correction intra-ocular lenses, which must be evaluated carefully in the ISBCS approach.
Collapse
Affiliation(s)
- Ali Nowrouzi
- Cornea, Cataract and Refractive Surgery Unit, Department of Ophthalmology, Hospital Quironsalud Marbella, Marbella
| | - Jorge L Alió
- Research and Development Department, and Refractive Surgery Department, VISSUM, VISSUM Instituto Oftalmológico de Alicante, Grupo Miranza
- Department of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| |
Collapse
|
15
|
Tavakoli K, Kalaw FGP, Bhanvadia S, Hogarth M, Baxter SL. Concept Coverage Analysis of Ophthalmic Infections and Trauma among the Standardized Medical Terminologies SNOMED-CT, ICD-10-CM, and ICD-11. OPHTHALMOLOGY SCIENCE 2023; 3:100337. [PMID: 37449050 PMCID: PMC10336190 DOI: 10.1016/j.xops.2023.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 07/18/2023]
Abstract
Purpose Widespread electronic health record adoption has generated a large volume of data and emphasized the need for standardized terminology to describe clinical concepts. Here, we undertook a systematic concept coverage analysis to determine the representation of clinical concepts in ophthalmic infection and ophthalmic trauma among standardized medical terminologies, including the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT), the International Classification of Diseases (ICD) version 10 with clinical modifications (ICD-10-CM), and ICD version 11 (ICD-11). Design Extraction of concepts related to ophthalmic infection and ophthalmic trauma and structured search in terminology browsers. Data Sources The American Academy of Ophthalmology Basic and Clinical Science Course (BCSC), SNOMED-CT, and ICD-10-CM terminologies from the Observational Health Data Sciences and Informatics Athena browser, and the ICD-11 terminology browser. Methods Concepts pertaining to ophthalmic infection and ophthalmic trauma were extracted from the 2022 BCSC free text and index terms. We searched terminology browsers to identify corresponding codes and classified the extent of semantic alignment as equal, wide, narrow, or unmatched in each terminology. The overlap of equal concepts in each terminology was represented in a Venn diagram. Main Outcome Measures Proportions of clinical concepts with corresponding codes at various levels of semantic alignment. Results A total of 443 concepts were identified: 304 concepts related to ophthalmic infection and 139 concepts related to ophthalmic trauma. The SNOMED-CT had the highest proportion of equal coverage, with 82.0% (249 of 304) among concepts related to ophthalmic infection and 82.0% (115 of 139) among concepts related to ophthalmic trauma. Across all concepts, 28% (124 of 443) were classified as equal in ICD-10-CM and 52.8% (234 of 443) were classified as equal in ICD-11. Conclusions The SNOMED-CT had significantly better semantic alignment than ICD-10-CM and ICD-11 for ophthalmic infections and ophthalmic trauma. This demonstrates opportunity for continuing advancement of representation of ophthalmic concepts in standardized medical terminologies.
Collapse
Affiliation(s)
- Kiana Tavakoli
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
| | - Fritz Gerald P. Kalaw
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
| | - Sonali Bhanvadia
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
| | - Michael Hogarth
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
| | - Sally L. Baxter
- Division of Ophthalmology Informatics and Data Science, Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, La Jolla, California
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
| |
Collapse
|
16
|
Chun LY, Tanenbaum RE, Liao C, Rodriguez SH. The association between developmental delay and endophthalmitis after pediatric cataract surgery using an insurance claims database. J AAPOS 2023; 27:331.e1-331.e6. [PMID: 39195355 DOI: 10.1016/j.jaapos.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 08/29/2024]
Abstract
PURPOSE To evaluate risk factors for postoperative endophthalmitis in pediatric cataract surgery based on an analysis of a large insurance claims database. METHODS We retrospectively analyzed pediatric (0-18 years) cataract surgeries from the IBM MarketScan Research Database from 2004 to 2017. Suspect cases of endophthalmitis were identified by International Classification of Diseases codes; confirmed cases, by Current Procedural Terminology codes within 7 days of diagnosis. Odds ratios (OR) were assessed for age, sex, aphakia, concomitant vitrectomy, open-globe injury, uveitis, lens displacement, developmental delay, trisomy 21, and immunocompromised status. RESULTS Among 5,304 eyes of 6,835 patients, the following were factors significantly associated with pediatric cataract surgery-related suspect endophthalmitis: open-globe injury (OR = 7.75; 95% CI, 3.32-18.09; P < 0.001), ocular trauma (OR = 3.64; 95% CI, 1.83-7.24; P < 0.001), aphakia (OR = 2.33, CI 1.15-4.69, P = 0.018), and developmental delay (OR = 4.24, 95% CI, 1.00-18.02; P = 0.05). With univariate analysis of confirmed endophthalmitis cases, the following were identified as statistically significant: open-globe injury (OR = 8.1; 95% CI, 2.64-24.87; P < 0.001), ocular trauma (OR = 4.34, CI 1.72-10.97; P = 0.002), subluxated or dislocated lens (OR = 3.62; 95% CI, 1.04-12.57; P = 0.043), aphakia (OR = 2.86; 95% CI, 1.13-7.26; P = 0.027), and developmental delay (OR = 8.24; 95% CI, 1.86-36.44; P = 0.005). Age, sex, concomitant vitrectomy, and uveitis were not associated with increased risk of endophthalmitis. CONCLUSIONS Developmental delay may be a risk factor for postoperative endophthalmitis in pediatric cataract surgery. Surgeons can assess preoperative risk by performing a detailed medical and social history for challenges particular to this population that may complicate the postoperative course.
Collapse
Affiliation(s)
- Lindsay Y Chun
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois
| | - Rebecca E Tanenbaum
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois
| | - Chuanhong Liao
- Biostatistics Laboratory & Research Computing Group, University of Chicago, Chicago, Illinois
| | - Sarah Hilkert Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois; Department of Pediatrics, University of Chicago, Chicago, Illinois.
| |
Collapse
|
17
|
Ali M, Lorch AC, Woreta F. Assessing Quality Metrics in Ophthalmic Surgery: A Standardized Approach. OPHTHALMOLOGY SCIENCE 2023; 3:100415. [PMID: 38124773 PMCID: PMC10733084 DOI: 10.1016/j.xops.2023.100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
|
18
|
Aiello F, Gallo Afflitto G, Leviste K, Swaminathan SS, Yoo SH, Findl O, Maurino V, Nucci C. Immediate sequential vs delayed sequential bilateral cataract surgery: systematic review and meta-analysis. J Cataract Refract Surg 2023; 49:1168-1179. [PMID: 37276258 DOI: 10.1097/j.jcrs.0000000000001230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 06/07/2023]
Abstract
The main aim of this systematic review and meta-analysis was to evaluate the safety and efficacy profile of immediate sequential bilateral cataract surgery (ISBCS) compared with delayed sequential bilateral cataract surgery (DSBCS). MEDLINE Ovid, EMBASE, and CENTRAL databases were searched. Outcome measures were postoperative visual acuity, postoperative spherical equivalent (refractive outcome), endophthalmitis, corneal edema, pseudophakic macular edema, and posterior capsule rupture (PCR). 13 articles met criteria for final inclusion. A total of 11 068 622 participants (18 802 043 eyes) were included. No statistically significant differences between ISBCS and DSBCS were identified in all the postoperative outcomes evaluated. However, a higher risk for PCR was identified in the ISBCS group from the pooled analysis of nonrandomized studies (risk ratio, 1.34, 95% CI, 1.08-1.67, P = .0081). In our view, the ISBCS approach has an acceptable safety-efficacy profile, comparable with DSBCS. Future investigations are warranted, with a focus on the analysis of risk factors for surgical complications, patient-reported outcome-measures, and cost effectiveness.
Collapse
Affiliation(s)
- Francesco Aiello
- From the Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy (Aiello, Gallo Afflitto, Nucci); Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (Gallo Afflitto, Leviste, Swaminathan, Yoo); Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom (Maurino); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl)
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Kugler LJ, Kapeles MJ, Durrie DS. Safety of office-based lens surgery: U.S. multicenter study. J Cataract Refract Surg 2023; 49:907-911. [PMID: 37276271 DOI: 10.1097/j.jcrs.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE To evaluate the rate of adverse events after office-based lens surgery performed across multiple private practices in the United States. SETTING 36 private practices across the U.S. DESIGN Retrospective multicenter study. METHODS This analysis included case records of all consecutive patients who underwent office-based lens surgery for visually significant cataract, refractive lens exchange, or phakic intraocular lens implantation between August 2020 and May 2022 at 36 participating sites across the U.S. The study outcome measures included the assessment of intraoperative and postoperative complications such as the incidence of unplanned vitrectomy, iritis, corneal edema, and endophthalmitis after lens surgery. The frequency of patients requiring a return to the operating room (OR) or referral to a retina surgeon and the frequency of patients requiring hospitalization or calling emergency services (911) for any reason were also evaluated. RESULTS The study reviewed 18 005 cases of office-based cataract or refractive lens surgery performed at 36 clinical sites. The rates of postoperative endophthalmitis, toxic anterior segment syndrome, and corneal edema were 0.028%, 0.022%, and 0.027%, respectively. Unplanned anterior vitrectomy was performed in 0.177% of patients. Although 0.067% of patients needed to return to the OR, 0.011% of patients were referred to the hospital. CONCLUSIONS The rate of adverse events for office-based cataract or refractive lens surgery is similar to or less than the reported adverse event rate for modern cataract surgery in the ambulatory surgery center setting.
Collapse
Affiliation(s)
- Lance J Kugler
- From the Kugler Vision, Omaha, Nebraska (Kugler, Kapeles); iOR Partners, Kansas City, Missouri (Durrie)
| | | | | |
Collapse
|
20
|
Hannan SJ, Schallhorn SC, Venter JA, Teenan D, Schallhorn JM. Immediate Sequential Bilateral Surgery in Refractive Lens Exchange Patients: Clinical Outcomes and Adverse Events. Ophthalmology 2023; 130:924-936. [PMID: 37086858 DOI: 10.1016/j.ophtha.2023.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/24/2023] Open
Abstract
PURPOSE To evaluate outcomes and the incidence of adverse events (AEs) in patients who underwent bilateral same-day refractive lens exchange (RLE). DESIGN Retrospective case series. PARTICIPANTS Patients of a private intraocular surgery provider in the United Kingdom who underwent RLE in both eyes on the same day with treatment dates between March 2018 and December 2021. METHODS Clinical outcomes and AEs were collected for a continuous cohort of patients undergoing bilateral same-day RLE (in the absence of visually significant cataracts) or had mild cataracts (corrected visual acuity ≥ 20/40). One-month clinical outcomes were analyzed. MAIN OUTCOME MEASURES Refractive outcomes and visual acuity, intraoperative and postoperative AEs, and secondary surgical interventions recorded within the first month after surgery. RESULTS A total of 17 330 patients (34 660 eyes) were included in the analysis. Of these, 28 827 eyes received a multifocal intraocular lens (IOL), and 5833 eyes had a monofocal IOL. The percentage of eyes within ±0.50 diopters (D) of intended refraction was 85.5% and 86.2% for monofocal and multifocal IOL eyes, respectively. There was a total of 55 intraoperative AEs recorded in 55 eyes of 54 patients (per-eye incidence: 0.159%). Posterior capsule tear was the most common intraoperative event occurring in 37 eyes (0.107%). The number of AEs recorded within the first postoperative month was 267, occurring in 263 eyes of 177 patients (per-eye incidence: 0.759%). These included cystoid macular edema (CME) (172 eyes; 0.496%), significant corneal edema (28 eyes; 0.081%), persistent inflammation (27 eyes; 0.078%), significantly raised intraocular pressure (27 eyes; 0.078%), toxic anterior segment syndrome (8 eyes; 0.023%), wound leak (3 eyes; 0.009%), retinal detachment (1 eye; 0.003%), and retinal tear (1 eye; 0.003%). There were 56 secondary surgical interventions recorded within the first month of surgery, occurring in 54 eyes of 47 patients (per-eye incidence: 0.156%). The most common secondary intervention was the rotation of a misaligned toric IOL (24 eyes; 0.069%). CONCLUSIONS Elective same-day bilateral RLE had a low incidence of serious AEs, and high refractive predictability. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
| | - Steven C Schallhorn
- Optical Express, Glasgow, United Kingdom; University of California, San Francisco, Department of Ophthalmology, San Francisco, California; Carl Zeiss Meditec, Inc., Dublin, California
| | | | | | - Julie M Schallhorn
- University of California, San Francisco, Department of Ophthalmology, San Francisco, California; F.I. Proctor Foundation, University of California, San Francisco, California.
| |
Collapse
|
21
|
Spekreijse L, Simons R, Winkens B, van den Biggelaar F, Dirksen C, Bartels M, de Crom R, Goslings O, Joosse M, Kasanardjo J, Lansink P, Ponsioen T, Reus N, Schouten J, Nuijts R. Safety, effectiveness, and cost-effectiveness of immediate versus delayed sequential bilateral cataract surgery in the Netherlands (BICAT-NL study): a multicentre, non-inferiority, randomised controlled trial. Lancet 2023; 401:1951-1962. [PMID: 37201546 DOI: 10.1016/s0140-6736(23)00525-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND In an ageing population, efficiency improvements are required to assure future accessibility of cataract care. We aim to address remaining knowledge gaps by evaluating the safety, effectiveness, and cost-effectiveness of immediate sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS). We hypothesised that ISBCS is non-inferior to DSBCS, regarding safety and effectiveness, and being superior in cost-effectiveness. METHODS We did a multicentre, non-inferiority, randomised controlled trial, which included participants from ten Dutch hospitals. Eligible participants were 18 years or older, underwent expected uncomplicated surgery, and had no increased risk of endophthalmitis or refractive surprise. Participants were randomly assigned (1:1) to either the ISBCS (intervention) group or DSBCS (conventional procedure) group, using a web-based system stratified by centre and axial length. Participants and outcome assessors were not masked to the treatment groups because of the nature of the intervention. The primary outcome was the proportion of second eyes with a target refractive outcome of 1·0 dioptre (D) or less 4 weeks postoperatively, with a non-inferiority margin of -5% for ISBCS versus DSBCS. For the trial-based economic evaluation, the primary endpoint was the incremental societal costs per quality-adjusted life-year. All analyses were done by a modified intention-to-treat principle. Costs were calculated by multiplying volumes of resource use with unit cost prices and converted to 2020 Euros (€) and US$. This study was registered with ClinicalTrials.gov, number NCT03400124, and is now closed for recruitment. FINDINGS Between Sept 4, 2018, and July 10, 2020, a total of 865 patients were randomly assigned to either the ISBCS group (427 [49%] patients; 854 eyes) or DSBCS group (438 [51%] patients; 876 eyes). In the modified intention-to-treat analysis, the proportion of second eyes with a target refraction of 1·0 D or less was 97% (404 of 417 patients) in the ISBCS group versus 98% (407 of 417) in the DSBCS group. The percentage difference was -1% (90% CI -3 to 1; p=0·526), thereby establishing non-inferiority for ISBCS compared with DSBCS. Endophthalmitis was not observed or reported in either group. Adverse events were comparable between groups, with only a significant difference in disturbing anisometropia (p=0·0001). Societal costs were €403 (US$507) lower with ISBCS than with DSBCS. The cost-effectiveness probability of ISBCS versus DSBCS was 100% across the willingness-to-pay range of €2500-80 000 (US$3145-100 629) per quality-adjusted life-year. INTERPRETATION Our results showed non-inferiority of ISBCS versus DSBCS regarding effectiveness outcomes, comparable safety, and superior cost-effectiveness of ISBCS. National cost savings could amount to €27·4 million (US$34·5 million) annually, advocating for ISBCS if strict inclusion criteria are applied. FUNDING Research grant from The Netherlands Organization for Health Research and Development (ZonMw) and Dutch Ophthalmological Society.
Collapse
Affiliation(s)
- Lindsay Spekreijse
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.
| | - Rob Simons
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Department of Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Frank van den Biggelaar
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Carmen Dirksen
- Department of Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Marjolijn Bartels
- Department of Ophthalmology, Deventer Hospital, Deventer, Netherlands
| | - Ronald de Crom
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, Netherlands; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, Netherlands
| | - Oege Goslings
- Department of Ophthalmology, Elisabeth TweeSteden Hospital, Tilburg, Netherlands
| | - Maurits Joosse
- Department of Ophthalmology, Medical Center Haaglanden, Den Haag, Netherlands
| | | | - Peter Lansink
- Department of Ophthalmology, Medical Spectrum Twente, Enschede, Netherlands
| | | | - Nic Reus
- Department of Ophthalmology, Amphia Hospital, Breda, Netherlands
| | - Jan Schouten
- Department of Ophthalmology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Rudy Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center+, Maastricht, Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands; Department of Ophthalmology, Zuyderland Medical Center, Heerlen, Netherlands
| |
Collapse
|
22
|
Soh ZD, Cheng CY. Application of big data in ophthalmology. Taiwan J Ophthalmol 2023; 13:123-132. [PMID: 37484625 PMCID: PMC10361443 DOI: 10.4103/tjo.tjo-d-23-00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/02/2023] [Indexed: 07/25/2023] Open
Abstract
The advents of information technologies have led to the creation of ever-larger datasets. Also known as big data, these large datasets are characterized by its volume, variety, velocity, veracity, and value. More importantly, big data has the potential to expand traditional research capabilities, inform clinical practice based on real-world data, and improve the health system and service delivery. This review first identified the different sources of big data in ophthalmology, including electronic medical records, data registries, research consortia, administrative databases, and biobanks. Then, we provided an in-depth look at how big data analytics have been applied in ophthalmology for disease surveillance, and evaluation on disease associations, detection, management, and prognostication. Finally, we discussed the challenges involved in big data analytics, such as data suitability and quality, data security, and analytical methodologies.
Collapse
Affiliation(s)
- Zhi Da Soh
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Centre for Innovation and Precision Eye Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| |
Collapse
|
23
|
Cicinelli MV, Buchan JC, Nicholson M, Varadaraj V, Khanna RC. Cataracts. Lancet 2023; 401:377-389. [PMID: 36565712 DOI: 10.1016/s0140-6736(22)01839-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/03/2022] [Accepted: 09/15/2022] [Indexed: 12/24/2022]
Abstract
94 million people are blind or visually impaired globally, and cataract is the most common cause of blindness worldwide. However, most cases of blindness are avoidable. Cataract is associated with decreased quality of life and reduced life expectancy. Most cases of cataract occur after birth and share ageing and oxidative stress as primary causes, although several non-modifiable and modifiable risk factors can accelerate cataract formation. In most patients, phacoemulsification with intraocular lens implantation is the preferred treatment and is highly cost-effective. There has been an increase in the use of comprehensive cataract surgical services, including diagnoses, treatment referrals, and rehabilitation. However, global inequity in surgical service quality is still a limitation. Implementation of preoperative risk assessment, risk reduction strategies, and new surgical technologies have made cataract surgery possible at an earlier stage of cataract severity with the expectation of good refractive outcomes. The main challenge is making the service that is currently available to some patients accessible to all by use of universal health coverage.
Collapse
Affiliation(s)
- Maria Vittoria Cicinelli
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Ophthalmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - John C Buchan
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Maneck Nicholson
- Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | | | - Rohit C Khanna
- Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye Care, Hyderabad, India; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India; School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia; School of Medicine and Dentistry, University of Rochester, Rochester, NY, USA.
| |
Collapse
|
24
|
Ting DSJ, Deshmukh R, Ting DSW, Ang M. Big data in corneal diseases and cataract: Current applications and future directions. Front Big Data 2023; 6:1017420. [PMID: 36818823 PMCID: PMC9929069 DOI: 10.3389/fdata.2023.1017420] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
The accelerated growth in electronic health records (EHR), Internet-of-Things, mHealth, telemedicine, and artificial intelligence (AI) in the recent years have significantly fuelled the interest and development in big data research. Big data refer to complex datasets that are characterized by the attributes of "5 Vs"-variety, volume, velocity, veracity, and value. Big data analytics research has so far benefitted many fields of medicine, including ophthalmology. The availability of these big data not only allow for comprehensive and timely examinations of the epidemiology, trends, characteristics, outcomes, and prognostic factors of many diseases, but also enable the development of highly accurate AI algorithms in diagnosing a wide range of medical diseases as well as discovering new patterns or associations of diseases that are previously unknown to clinicians and researchers. Within the field of ophthalmology, there is a rapidly expanding pool of large clinical registries, epidemiological studies, omics studies, and biobanks through which big data can be accessed. National corneal transplant registries, genome-wide association studies, national cataract databases, and large ophthalmology-related EHR-based registries (e.g., AAO IRIS Registry) are some of the key resources. In this review, we aim to provide a succinct overview of the availability and clinical applicability of big data in ophthalmology, particularly from the perspective of corneal diseases and cataract, the synergistic potential of big data, AI technologies, internet of things, mHealth, and wearable smart devices, and the potential barriers for realizing the clinical and research potential of big data in this field.
Collapse
Affiliation(s)
- Darren S. J. Ting
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom,Birmingham and Midland Eye Centre, Birmingham, United Kingdom,Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom,*Correspondence: Darren S. J. Ting ✉
| | - Rashmi Deshmukh
- Department of Cornea and Refractive Surgery, LV Prasad Eye Institute, Hyderabad, India
| | - Daniel S. W. Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore,Department of Ophthalmology and Visual Sciences, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore,Department of Ophthalmology and Visual Sciences, Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| |
Collapse
|
25
|
Rodriguez SH, Chun LY, Skondra D, Liao C. Association between Aphakia and Endophthalmitis after Pediatric Cataract Surgery. Ophthalmology 2023; 130:551-553. [PMID: 36646582 DOI: 10.1016/j.ophtha.2022.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/18/2022] [Accepted: 11/28/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- Sarah Hilkert Rodriguez
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois.
| | - Lindsay Y Chun
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
| | - Dimitra Skondra
- Department of Ophthalmology and Visual Science, University of Chicago Medical Center, Chicago, Illinois
| | - Chuanhong Liao
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| |
Collapse
|
26
|
Abstract
PURPOSE OF REVIEW The aim of this study was to present an overview of recent publications and opinions in the field of same-day bilateral cataract surgery. RECENT FINDINGS A Cochrane review was published comparing immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) with regard to safety outcomes, costs and cost-effectiveness. In addition, several large database studies provided more information on incidences of rare complications such as unilateral and bilateral endophthalmitis rates. SUMMARY Recently available evidence showed that ISBCS is an effective and cost-effective alternative to DSBCS. Nonetheless, additional (randomized) registry studies, randomized controlled trials and cost-effectiveness studies are needed to evaluate bilateral endophthalmitis rates, refractive outcomes and cost-effectiveness of ISBCS compared with DSBCS.
Collapse
Affiliation(s)
- Lindsay S Spekreijse
- Maastricht University Medical Center+, University Eye Clinic Maastricht, Maastricht, the Netherlands
| | | |
Collapse
|
27
|
Immediate or Delayed Sequential Bilateral ICL Surgery: a Survey of Chinese Ophthalmologists. Ophthalmol Ther 2022; 12:217-237. [PMID: 36331756 PMCID: PMC9638457 DOI: 10.1007/s40123-022-00599-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION In China, the demand for implantable collamer lens (ICL) surgery is booming. Immediate sequential bilateral ICL surgery (ISBICLS) benefits patients and clinics, but it remains controversial and lacks standardization. We aim to investigate the prevalence of, factors for, and surgeon attitudes toward ISBICLS. METHODS In this cross-sectional survey study, an electronic questionnaire about the practice and attitudes toward performing ISBICLS or delayed sequential bilateral ICL surgery (DSBICLS) was distributed to 792 qualified ICL surgeons in Mainland China, between 4 April and 22 April 2022. RESULTS A total of 531 surgeons (66.79%) from 30 provinces in Mainland China responded. Among them, 374 (67.23%) were currently performing ISBICLS. Fifty-two percent (277) of surgeons reported performing ISBICLS more than 50% of the time, while 85.05% of surgeons chose to perform the second eye surgery 1 day after the first eye surgery. Seventy percent (248) of surgeons performing ISBICLS chose to perform the second eye surgery less than 30 min after the first eye surgery. Surgeons who started ICL surgery earlier (before 2010, OR = 2.772, 95% CI = 1.290-5.957, P = 0.009; 2011-2013, OR = 2.479, 95% CI = 1.060-5.800, P = 0.036), completed one-eye ICL surgery faster (< 3 min, OR = 3.936, 95% CI = 1.505-10.293, P = 0.005) and modified the second eye ICL selection less frequently (1-25%, OR = 0.203, 95% CI = 0.054-0.771, P = 0.019; 26-50%, OR = 0.173, 95% CI = 0.041-0.726, P = 0.017; 51-75%, OR = 0.299, 95% CI = 0.041-0.726, P = 0.123; 76-100%, OR = 0.163, 95% CI = 0.039-0.688, P = 0.014) tended to perform ISBICLS. No significant association was found among clinical settings, preoperative measurement devices, and hospital policies with performing ISBICLS. Regarding their attitudes toward ISBICLS, 54.63% preferred ISBICLS and 45.37% preferred DSBICLS. The main supporting reasons were patient convenience (98.64%), faster vision rehabilitation (73.56%), and improved perioperative compliance (73.22%). The concerns regarding ISBICLS included the risk of endophthalmitis (62.22%), lack of recommendation in expert consensus (61.67%), and decreased vault predictability (60.93%). The most common desires for further adoption were expert consensus on surgical criteria and patient indicators for ISBICLS (82.3%). CONCLUSIONS ISBICLS has been gradually adopted in Mainland China, but has not been widely accepted as a routine procedure. Surgeons' experience and skills mainly influence whether ISBICLS is performed. Further research is needed to explore standardized protocols to prevent endophthalmitis, the appropriate time interval of two eye surgery, and requisitions for surgeon skills.
Collapse
|
28
|
Kwedar K, Arnold J, Hesemann N. Visual recovery after immediate sequential bilateral cataract surgery at a veterans' hospital. J Cataract Refract Surg 2022; 48:1260-1263. [PMID: 35537990 DOI: 10.1097/j.jcrs.0000000000000966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To answer patient questions about the expected timeline for recovery, the objective postoperative visual acuities were reviewed for patients undergoing immediate sequential bilateral cataract surgery (ISBCS). SETTING Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri. DESIGN Retrospective chart review. METHODS All patients who underwent ISBCS in 2019 were evaluated. A total of 116 patients (232 eyes) were studied. Uncorrected distance visual acuity (UDVA) for postoperative day 0 or 1 (POD0/1), postoperative week 1 (POW1), and postoperative month 1 (POM1) were required for study inclusion. Patients with ocular comorbidities were not excluded, although all patients passed an initial screening to qualify for ISBCS. The outcome measures included POD0/1, POW1, and POM1 UDVA. RESULTS Postoperative UDVA was stable or improved compared with preoperative corrected distance visual acuity (CDVA) for 48% (66/138) of eyes on POD0, 79% (74/94) of eyes on POD1, and 90% (209/232) of eyes on POW1. 83% of patients at POD1 and 90% of patients at POW1 had stable or improved visual acuity in at least 1 eye. 92% (214/232) of eyes had a POW1 UDVA of 20/40 or better. Of the 18 eyes with a postoperative POW1 UDVA of 20/50 or worse, 5 (28%) were known preoperatively to have limited visual potential. 99% (115/116) of patients had at least 1 eye 20/40 or better. CONCLUSIONS Most of the patients who underwent ISBCS demonstrated meaningful improvement in UDVA compared with preoperative CDVA as early as POD1. These results serve to guide discussion of postoperative expectations with patients interested in ISBCS.
Collapse
Affiliation(s)
- Kathleen Kwedar
- From the Ophthalmology Department, University of Missouri, Columbia, Missouri (Kwedar, Arnold, Hesemann); Harry S. Truman Memorial Veterans' Hospital, Columbia, Missouri (Hesemann)
| | | | | |
Collapse
|
29
|
Immediate sequential bilateral cataract surgery: time for wider adoption. J Cataract Refract Surg 2022; 48:1231-1232. [PMID: 36315625 DOI: 10.1097/j.jcrs.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
30
|
Pershing S, Lum F. The American Academy of Ophthalmology IRIS Registry (Intelligent Research In Sight): current and future state of big data analytics. Curr Opin Ophthalmol 2022; 33:394-398. [PMID: 35916568 PMCID: PMC10849939 DOI: 10.1097/icu.0000000000000869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To describe the drivers, development, and current state of the American Academy of Ophthalmology IRIS Registry (Intelligent Research In Sight), and analytics involving deidentified aggregate IRIS Registry data. RECENT FINDINGS The IRIS Registry has a core mission of quality improvement and reporting. In addition, analytic projects performed to date have included characterizing patient populations and diseases, incidence, and prevalence; clinical outcomes and complications; risk factors and effect modifiers; practice patterns; and trends over time. Pipeline projects include application of artificial intelligence and machine learning approaches for predictive modeling and analytics, disease mapping, detecting patterns and identifying cohorts, and optimizing treatment based on patient-specific characteristics. SUMMARY The IRIS Registry is the nation's largest single specialty clinical registry, with unique data elements specific to ophthalmology. It offers a wealth of opportunities involving big data analytics, including traditional inferential statistics as well as machine learning and artificial intelligence approaches scalable on massive amounts of data.
Collapse
Affiliation(s)
- Suzann Pershing
- Byers Eye Institute at Stanford, Department of Ophthalmology, Stanford University
- Ophthalmology and Eye Care Services, VA Palo Alto Healthcare System, Palo Alto
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California, USA
| |
Collapse
|
31
|
Rush SW, Omoruyi F, Rush RB. Patient Attitudes and Desirability Regarding Immediate Sequential Bilateral Cataract Surgery. Clin Ophthalmol 2022; 16:1375-1381. [PMID: 35520108 PMCID: PMC9064052 DOI: 10.2147/opth.s363327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To analyze patient attitudes and desirability regarding routine immediate sequential bilateral cataract surgery (ISBCS). Methods This study was conducted as a prospective, consecutive survey-based case series from a single private practice institution serving a mostly rural population. A standardized phone survey assessing patient perspectives on ISBCS was administered to patients before and after routine delayed sequential bilateral cataract surgery (DSBCS) was performed. Subject responses were analyzed, including a subset analysis on patient responses under a variety of circumstances. Results There were 61 patients enrolled into the study and 47 completed the surveys before and after routine DSBCS (77.0% completion rate). Thirty-nine (83.0%) of respondents had a favorable outlook of ISBCS preoperatively, whereas 36 (76.6%) had a favorable outlook of ISBCS postoperatively (p>0.05). On the postoperative questionnaire, twenty-five (53.2%) of respondents were willing to accept additional surgical risk if necessary to receive ISBCS, and this finding was significant between the subgroup of patients with systemic health co-morbidities compared to those without systemic health co-morbidities (p=0.05). Conclusion Most patients had a favorable outlook of ISBCS before and after undergoing DSBCS. Patients with underlying systemic health co-morbidities were most likely to accept additional surgical risk if necessary to receive ISBCS. From a patient’s perspective, ISBCS may be an acceptable option to routinely implement when cataract surgery is required for both eyes.
Collapse
Affiliation(s)
- Sloan W Rush
- Rush Eye Associates, Amarillo, TX, 79106, USA
- Texas Tech University Health Science Center, Amarillo, TX, 79106, USA
| | - Felix Omoruyi
- Texas Tech University Health Science Center, Amarillo, TX, 79106, USA
| | - Ryan B Rush
- Texas Tech University Health Science Center, Amarillo, TX, 79106, USA
- Southwest Retina Specialists, Amarillo, TX, 79106, USA
- Correspondence: Ryan B Rush, Southwest Retina Specialists, 7411 Wallace Blvd, Amarillo, TX, 79106, USA, Tel +1-806 351-1870, Email
| |
Collapse
|
32
|
Ophthalmologists' attitudes towards immediate sequential bilateral cataract surgery (ISBCS): a Dutch national survey. J Cataract Refract Surg 2022; 48:1044-1049. [PMID: 35239579 PMCID: PMC9415210 DOI: 10.1097/j.jcrs.0000000000000922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate current practice patterns of immediate sequential bilateral cataract surgery (ISBCS) in the Netherlands and assess ophthalmologists' attitudes towards performing ISBCS in future cataract care. SETTING Dutch ophthalmic society members. DESIGN Cross-sectional study (national survey). METHODS An electronic survey on ISBCS was sent as part of an annual survey on cataract practice patterns to members of the Dutch ophthalmic society. Questions regarding current ISBCS practice patterns, willingness to perform ISBCS routinely in future care, reasons for performing ISBCS and reasons for not performing ISBCS were included. Data were analysed using descriptive statistics. RESULTS In total, 237/520 survey recipients (45.6%) responded to the overall survey. Data on the ISBCS questions was available from 227 respondents. Sixty-two ophthalmologists (27.3%) currently performed ISBCS, predominantly in low patient-volumes (90.3% in one to five patients per month). However, 108/227 ophthalmologists (47.6%) considered performing ISBCS routinely in future practice. Procedures for which ISBCS was mainly considered included age-related cataract surgery using topical and general anaesthesia. Availability of separate products and instruments for both eyes and patient advantages were considered of high importance when performing ISBCS. Main reasons for not performing ISBCS included the risk of endophthalmitis and potential medico-legal aspects. CONCLUSIONS Although ISBCS is currently no routine procedure in the Netherlands, it is considered by almost 50% of surgeons. In order to improve implementation on a national level, potential barriers identified in this survey (fear of bilateral endophthalmitis, potential medico-legal issues, a lack of availability of separate products for both eyes) should be addressed.
Collapse
|
33
|
Malwankar J, Son HS, Chang DF, Dun C, Woreta F, Prescott C, Makary M, Srikumaran D. Trends, Factors, and Outcomes Associated with Immediate Sequential Bilateral Cataract Surgery (ISBCS) Among Medicare Beneficiaries. Ophthalmology 2021; 129:478-487. [PMID: 34971649 DOI: 10.1016/j.ophtha.2021.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the incidence of immediate (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) and identify factors associated with undergoing ISBCS. DESIGN Retrospective cohort study. SUBJECTS Medicare beneficiaries aged ≥65 who underwent ISBCS and DSBCS from 2011 to 2019. METHODS Population-based analysis of the 100% Medicare fee-for-service carrier claims data. Logistic regression models were performed to evaluate factors associated with ISBCS. MAIN OUTCOME MEASURES 1) Incidence of ISBCS and DSBCS, 2) demographic, ocular and medical characteristics associated with receipt of ISBCS, and 3) rates of endophthalmitis and cystoid macular edema (CME) after ISBCS or DSBCS. RESULTS A total of 4,014 (0.2%) ISBCS and 1,944,979 (99.8%) DSBCS patients were identified. Black (OR:2.31, 95%CI: 2.06-2.59), Asian (OR:1.82, 95%CI: 1.51-2.12), or Native American (OR:2.42, 95%CI: 1.81-3.23) patients were more likely to receive ISBCS compared to White patients. Patients residing in rural areas had higher likelihood of ISBCS (OR:1.26, 95%CI: 1.17-1.35) compared to metropolitan areas. Patients operated at a hospital compared to ambulatory setting (OR:2.71, 95%CI: 2.53-2.89) were more likely to receive ISBCS. Patients with bilateral complex vs. non-complex cataract (OR:3.23, 95%CI: 2.95-3.53) were more likely to receive ISBCS. Patients with a Charlson comorbidity index (CCI) of 1-2 (OR:1.45, 95%CI: 1.29-1.62), 3-4 (OR:1.70, 95%CI: 1.47-1.97), 5-6 (OR:1.97, 95%CI: 1.62-2.39), and CCI≥7 (OR:1.97, 95%CI: 1.55-2.50) were all more likely to receive ISBCS compared to those with CCI=0. In contrast, patients with glaucoma (OR:0.82, 95%CI: 0.76-0.89), macular degeneration (OR:0.75, 95%CI: 0.68-0.82), and macular hole/epiretinal membrane (OR:0.55, 95%CI: 0.48-0.65) were less likely to undergo ISBCS compared to those without. Cumulatively, there was no significant difference in endophthalmitis rate within 42 days between ISBCS (1.74 per 1,000 ISBCS) and DSBCS (1.01 per 1,000 DSBCS; p=0.15). Similarly, there was no significant cumulative difference between ISBCS (1.79 per 100 ISBCS) and DSBCS (1.96 per 100 DSBCS) CME rates (p=0.48). CONCLUSION Overall utilization of ISBCS among Medicare beneficiaries remains low over the past decade, though rates of endophthalmitis and CME were comparable to DSBCS. Race, geography, systemic and ocular comorbidities were associated with receiving ISBCS. ISBCS represents a potential opportunity to improve access to cataract surgery.
Collapse
Affiliation(s)
- Jui Malwankar
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hyeck-Soo Son
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fasika Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Christina Prescott
- Department of Ophthalmology, New York University Langone Health, New York, NY
| | - Martin Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Divya Srikumaran
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
| |
Collapse
|
34
|
Yusuf IH, Matsou A, Lake D, Bostancı B, Nanavaty MA. Comment on: Immediately sequential bilateral cataract surgery (ISBCS): an Academic Teaching Center's experience. J Cataract Refract Surg 2021; 47:1604. [PMID: 34846345 DOI: 10.1097/j.jcrs.0000000000000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Imran H Yusuf
- Nuffield Laboratory of Ophthalmology, Department of Clinical Neurosciences, University of Oxford, United Kingdom; Oxford Eye Hospital, John Radcliffe, Oxford, United Kingdom
| | - Artemis Matsou
- Queen Victoria Hospital, East Grinstead, London, United Kingdom
| | - Damian Lake
- Queen Victoria Hospital, East Grinstead, London, United Kingdom
| | - Başak Bostancı
- Okan University Faculty of Medicine, Department of Ophthalmology, İstanbul, Turkey
| | - Mayank A Nanavaty
- Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| |
Collapse
|