Differential diagnosis of acute ocular pain: Teleophthalmology during COVID-19 pandemic - A perspective

Painful Eyes in Neurology Clinic: A Guide for Neurologists

Eye pain is a common complaint among patients presenting to the neurology clinic. It can be related to neurologic diseases, but it can also be a localized eye condition. Such disorders can be misleading, as their benign appearance might mask more grave underlying conditions, potentially leading to misdiagnoses or delayed treatment. Clinicians should be aware of the specific neurologic or systemic disorders (eg, demyelinating diseases or vascular abnormalities) that might first manifest as eye pain. Formal ophthalmic consultation is recommended for patients presenting with eye pain as the predominant complaint especially when red flags for more serious pathology are present.

Developing a Measure to Quantify Ocular Pain Postoperatively: The Adaptation of the Ocular Pain Assessment Survey

Purpose

Since quantification and communication of ocular pain is important for a healthier patient follow-up and postoperative guidance, reliable measures like the Ophthalmic Pain Assessment Survey (OPAS) are needed to assess the outcome and management of different operations. To address that need, we carried out the adaptation of OPAS into Turkish to reach different age groups and backgrounds, widening the use of OPAS on patients who underwent an ophthalmic operation.

Methods

We used back-translation method and achieved cultural adaptation through content validity scoring by 5 independent ophthalmologists. The survey is then administered three times: preoperatively, postoperatively within 24 hours, and finally a week later in the follow-up visit. Validity is measured in comparison to Visual Analog Scale using Spearman's correlation coefficient and reliability is measured using Cronbach's alpha. Factor analysis is performed by principal component analysis and rotation is performed using Varimax method when necessary.

Results

We reached a total of 132 patients with a mean age of 64.2 years. Most of them underwent phacoemulsification (n = 83), followed by PRK (n = 37). Overall, the T-OPAS demonstrated good reliability (mean C. alpha: 0.830) and its correlation with the VAS was especially high (S. coeff. >0.5) in the first three sections in all three surveys. Factor analysis yielded 5 subscales, allowing us to shape the final form of T-OPAS.

Conclusion

Through this adaptation of OPAS into a foreign language, we present a reliable and valid tool for postoperative pain quantification, allowing objective measurement of pain in different populations such as the elderly.

Impact of teleconsultation on visual and refractive outcomes in patients undergoing laser refractive surgery during COVID-19

Purpose

To assess the role of remote teleconsultation (TC) follow-up care following a successful and uneventful laser vision correction.

Methods

The study is a retrospective, comparative analysis of patients undergoing laser vision correction at tertiary care eye hospital in Southern India. The patients were divided into two groups. The first group included patients operated on before the coronavirus disease (COVID-19) pandemic and were followed up with physical consultations during their follow-up visit (Group 1). The second group comprised patients operated on during the pandemic and had at least one remote TC during their post-operative follow-up (Group 2).

Results

A total of 1088 eyes of 564 patients and 717 eyes of 372 patients were included in Group 1 and 2, respectively. The mean number of visits for the patients from Group 2 during the COVID period (2.56 +/- 0.74 days) was significantly lesser (P < 0.0001) than that of Group 1 in the pre-COVID period (3.53 +/- 1.07 days). Close to 90% of the eyes achieved an uncorrected distance visual acuity (UDVA) of 20/20 in both groups (P = 0.925). 96.50% of the eyes in Group 1 and 98.18% of the eyes in Group 2 achieved UCVA 20/25 or better (P = 0.049). Eight eyes (0.73%) in Group 1 and one eye (0.14%) in Group 2 reported a loss of 2 or more lines. However, the results were not statistically significant (P = 0.156). None of the groups had any patients who had a sight-threatening complication.

Conclusion

Remote TC following refractive surgery is safe and can be effectively integrated into routine refractive practice to reduce travel to the hospital for a physical consult.

A modified UTAUT model for the acceptance and use of digital technology for tackling COVID-19

COVID-19 pandemic expedites the development of digital technologies to tackle the spread of the virus. Several digital interventions have been deployed to reduce the catastrophic impact of the pandemic and observe preventive measures. However, the adoption and utilization of these technologies by the affected populace has been a daunting task. Therefore, this study carried out exploratory investigation of the factors influencing the behavioural intention (BI) of people to accept COVID-19 digital tackling technologies (CDTT) using the UTAUT (Unified Theory of Acceptance and Use of Technology) framework. The study applied principal components analysis and multiple regression analysis for hypotheses testing. The study revealed that performance expectancy (PE), facilitating conditions (FC) and social influence (SI) are the best predictors of people's BI to accept CDTT. Also, organizational

influence and benefit (OIB) and government expectancy and benefits (GEB) influence the people's BI. However, variables such as age, gender and voluntariness to use CDTT have no significance to influence BI because the CDTT is still nascent and not easily accessible. The results show that the decision-makers and regulators should consider inciting variables such as PE, FC, SI, OIB and GEB, that motivate the acceptance and use of CDTT. Furthermore, the populace must be sensitized to the availability and use of CDTT in all communities. Also, the path diagram and hypothesis testing results for CDTT acceptance and use, will help government and private organizations in planning and responding to the digitalization of COVID-19 protective measures and hence revise the COVID-19 health protection regulation.

Application of intelligence-based computational techniques for classification and early differential diagnosis of COVID-19 disease

Clinical methods are used for diagnosing COVID-19 infected patients, but reports posit that, several people who were initially tested positive of COVID-19, and who had some underlying diseases, turned out having negative results after further tests. Therefore, the performance of clinical methods is not always guaranteed. Moreover, chest X-ray image data of COVID-19 infected patients are mostly used in the computational models for COVID-19 diagnosis, while the use of common symptoms, such as fever, cough, fatigue, muscle aches, headache, etc. in computational models is not yet reported. In this study, we employed seven classification algorithms to empirically test and verify their efficacy when applied to diagnose COVID-19 using the aforementioned symptoms. We experimented with Logistic Regression (LR), Support Vector Machine (SVM), Naïve Byes (NB), Decision Tree (DT), Multilayer Perceptron (MLP), Fuzzy Cognitive Map (FCM) and Deep Neural Network (DNN) algorithms. The techniques were subjected to random undersampling and oversampling. Our results showed that with class imbalance, MLP and DNN outperform others. However, without class imbalance, MLP, FCM and DNN outperform others with the use of random undersampling, but DNN has the best performance by utilizing random oversampling. This study identified MLP, FCM and DNN as better classifiers over LR, NB, DT and SVM, so that healthcare software system developers can adopt them to develop intelligence-based expert systems which both medical personnel and patients can use for differential diagnosis of COVID-19 based on the aforementioned symptoms. However, the test of performance must not be limited to the traditional performance metrics.

Teleophthalmology and Artificial Intelligence As Game Changers in Ophthalmic Care After the COVID-19 Pandemic

The current COVID-19 pandemic has boosted a sudden demand for telemedicine due to quarantine and travel restrictions. The exponential increase in the use of telemedicine is expected to affect ophthalmology drastically. The aim of this review is to discuss the utility, effectiveness and challenges of teleophthalmological new tools for eyecare delivery as well as its implementation and possible facilitation with artificial intelligence. We used the terms: “teleophthalmology,” “telemedicine and COVID-19,” “retinal diseases and telemedicine,” “virtual ophthalmology,” “cost effectiveness of teleophthalmology,” “pediatric teleophthalmology,” “Artificial intelligence and ophthalmology,” “Glaucoma and teleophthalmology” and “teleophthalmology limitations” in the database of PubMed and selected the articles being published in the course of 2015-2020. After the initial search, 321 articles returned as relevant. A meticulous screening followed and eventually 103 published manuscripts were included and used as our references. Emerging in the market, teleophthalmology is showing great potential for the future of ophthalmological care, benefiting both patients and ophthalmologists in times of pandemics. The spectrum of eye diseases that could benefit from teleophthalmology is wide, including mostly retinal diseases such as diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration but also glaucoma and anterior segment conditions. Simultaneously, artificial intelligence provides ways of implementing teleophthalmology easier and with better outcomes, contributing as significant changing factors for ophthalmology practice after the COVID-19 pandemic.

Publication trend of COVID-19 and non-COVID-19 articles in the Indian Journal of Ophthalmology during the pandemic

Purpose

To analyze the trend of COVID-19-related and non-COVID-19-related articles published in the Indian Journal of Ophthalmology (IJO) during the COVID-19 pandemic.

Methods

A retrospective analysis of all COVID-19 and non-COVID-19-related articles published in all the issues of IJO from January 2020 to March 2021 was performed. The data were obtained from the official website of IJO, Editor IJO monthly email, and PubMed. The monthly data were analyzed and a comparative analysis was done. The articles were segregated as Original, Review, Case Report/Series, Letter to the Editor/Commentary, Guest Editorial, Research methodology, Point-Counterpoint, Consensus Criteria, Ophthalmic Images, Photo Essay, Surgical Techniques, and AIOS Meeting Papers.

Results

Out of 1343 articles published in IJO during the pandemic, 182 (13.55%) were COVID-19-related and 1161 (86.45%) were non-COVID-19-related articles. Among COVID-19 articles (182), majority were letter to the editors 66 (36.26%), followed by original articles 39 (21.42%), commentaries 24 (13.18%), editorials 18 (9.89%), and preferred practices 13 (7.14%). The least were case reports five (2.74%), current ophthalmology and innovation three (1.64%) each, and one (0.54%) each of consensus criteria, images, and photo assays. In the non-COVID-19-related articles (1161), maximum were original articles 276 (23.77%), followed by case reports 179 (15.41%), photo assays 157 (13.52%), and commentaries 141 (12.14%). The least were three (0.25%) consensus criteria and two (0.17%) each of current ophthalmology and innovations. The lockdown issue with 223 articles, postlockdown phase 1 had 267, postlockdown phase 2 had 321, and postlockdown phase 3 with 316 (1127 articles) articles in IJO showed a rising trend in a number of published articles compared with the prelockdown issues (216 articles).

Conclusion

The quality and quantity of articles published in IJO increased and improved significantly. The results were seen with progressive improvement in citations and impact factors of the journal.

Impact of COVID-19 pandemic, national lockdown, and unlocking on an apex tertiary care ophthalmic institute

Purpose:

To evaluate the impact of 2019 COVID-19 pandemic, national lockdown, and unlocking on ophthalmic care provided by the government-funded apex health institute of India.

Methods:

Retrospective review of electronic medical records of all patients presenting to the ophthalmology department from March 23, 2020, to July 15, 2020, was compared with that from March 23, 2019, to July 15, 2019. The data between March 23, 2020, to May 31, 2020 (lockdown) and June 06, 2020, to July 15, 2020 (unlock) was compared separately. Parameters evaluated were age, gender, presenting complaints, final diagnosis, treatment advised, and surgical interventions.

Results:

During the lockdown, routine outpatient flow reduced by 97.14% (P < 0.001), the median age of presentation decreased to 29 years (55 years last year) and males increased by 4.7% (from 61.51% to 66.21%) in 2020. Emergency services decreased by 35.25%, percentage of children decreased by 4.28% (from 34.28% to 30%) and males increased by 13.53% (from 59.97% to 73.5%). Mechanical trauma, microbial keratitis, and conjunctivitis were the most common reasons for presentation. The former lessened by 41.75% while the latter two amplified by 1.25 times and 2 times, respectively. While sanitizer-associated chemical injury increased in proportion, endophthalmitis, and postoperative complications declined. The number of donor corneas collected and emergency therapeutic keratoplasties performed decreased by 99.61% and 92.39%, respectively (P < 0.001). During the unlocking phase, routine patient consultations were 71 ± 19/day, significantly lower than 978 ± 109/day of last year (P < 0.001). No voluntary eye donation was reported during this period.

Conclusion:

COVID-19 pandemic and national lockdown severely hampered the delivery of ophthalmic care by the apex-ophthalmic institute. Unlike anticipated, lifting of pandemic-associated lockdown served only minimally in improving patient inflow in its initial phases.