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New “Eye Chart” app, free for The Lens readers!
Dr. Michael Ullman has developed the "Eye Chart" app, a tool for eyecare professionals. This app utilizes the True Depth camera to gauge viewing distance. This functionality allows for calibration of the eye chart, ensuring reliable vision checks directly from the phone. It has a large variety of helpful optotypes like LEA figures and Allen figures. The app also includes features like an OKN drum and color plates. While it bears similarities to other apps, Dr. Ullman's integration of the True Depth feature significantly enhances the app's functionality. Also the app contains NO ads and NO required registration. Normally priced at $10 in the App Store, readers of 'The Lens' can contact Dr. Ullman at email@example.com, for a promo code to download the "Eye Chart" app free of charge.
In this week’s issue
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In the delicate realm of ophthalmic surgery, the use of opioids presents a complex dilemma, balancing appropriate pain management with the alarming risks of addiction and misuse. This retrospective cross sectional analysis of over 1.5 million patients sought to determine the negative effects of prescribing opioids after ophthalmic surgery. Of the patients studied, 20% filled an opioid prescription postoperatively. Filling an opioid prescription postoperatively was associated with increased mortality (Hazard Rate [HR] 1.28), hospitalization (HR 1.51), opioid overdose (HR 7.31), and opioid dependency (HR 13.05, p<0.001 for all) compared to no opioid prescription. Additionally, higher morphine milligram equivalent doses of opioids were associated with higher rates of mortality, hospitalization, abuse and dependence. Ophthalmologists should counsel patients appropriately about the risks of opioids after surgery, and use special judgment or alternative forms of pain control in patients with high risk for opioid misuse.
Who ends up with a site for sore eyes? The incidence of corneal ulcers is over 75,000 cases per year in the United States, giving rise to increased healthcare expenditure and concurrent ocular morbidity. While outpatient management suffices for a majority of cases, many elements contribute to severity and a need for inpatient care. Examining patient data from the Nationwide Inpatient Sample (NIS) between 2015 and 2020, this retrospective cross-sectional study aimed to investigate the impact of variables such as sex, race, medical comorbidities, and insurance status on prolonged inpatient stays for corneal ulcers. 50.2% of individuals analyzed (596/1187) had inpatient stays of <4 days, while 49.5% (588/1187) had longer stays. Prolonged stays were associated with Black patients, age >55, Medicare recipients, diabetes, legal blindness, dementia, alcohol use, and housing insecurity. The results suggest that individuals with characteristics linked to extended inpatient stays may not have been promptly identified in the early stages of their disease progression, potentially because of reduced access to the correct physicians.
American Journal of Ophthalmology
This article is anything but a dry read! Social determinants of health (SDOH) refer to non-medical factors that affect an individual's health and quality of life. The World Health Organization categorizes these into 5 broad categories: neighborhood and built environment, economic stability, social and community context, education, and health care access. Researchers in this study aim to highlight associations between SDOH and dry eye disease (DED) in hopes of expanding methods to quantify SDOH and identifying how these interactions affect patients with DED. Researchers performed a literature review and included 18 studies that reported both cross-sectional and longitudinal associations between SDOH and DED in their analysis. Of the 51 SDOH indicators reported by the studies, “neighborhood and built environment” was the most studied, whereas “access to healthcare” and “degree of education” were among the least studied domains. The majority of the indicators that were studied were associated with poor DED outcomes. While this study may only be able to offer a rudimentary recollection of reported associations between SDOH and DED, it highlights the importance of ongoing efforts to target and address disparities to ensure equitable access to eye care.
British Journal of Ophthalmology
In it for the LHON(g) haul! Leber hereditary optic neuropathy (LHON), a mitochondrial disorder, results in typically painless and central vision loss. This single-center retrospective study includes 1540 diagnostically confirmed LHON patients from 1977 to 2022. Disease history, phenotypic characteristics, and optical coherence tomography (OCT) scans for detailed assessment were collected, along with fundus photography for characterization of the optic disc. A total of 1540 patients were included. Of the 13 pathogenic mtDNA variants detected, m.11778GA and m.3460GA variants were significantly higher in this Chinese LHON population compared to other populations. Although some differences in presentations between males and females were found, they were not statistically significant. A younger-onset of symptoms and low optic disc grade are indicative of a favorable LHON prognosis. Limitations of this study include its retrospective design which may introduce biases, and lack of accounting for possible confounders affecting LHON such as smoking and diet. Moreover, this study is restricted to the Chinese population, limiting its generalizability.
Ophthalmic Plastic and Reconstructive Surgery
Is your child’s vision blurry? Congenital nasolacrimal duct obstruction (CNLDO) is a well known risk factor for the development of amblyopia and anisometropia. CNLDO resolution has also been found to be associated with varying rates of amblyopia and anisometropia in older infants. Researchers conducted a retrospective study of 462 patients greater than 9 months of age with early and late spontaneous resolution being compared against an intervention group for rates of amblyopia and anisometropia. Anisometropia was seen in (12/102) 12% of early versus (25/243) 10% of late patients (p = 0.686, 95% CI: –0.059, 0.088), and amblyopia in (4/131) 3% of early versus (14/286) 5% of late patients (p = 0.322, 95% CI: –0.061, 0.018). In patients presenting <24 months without undergoing surgery, spontaneous resolution occurred in 76% between 12 and 24 months (n = 41). To conclude, anisometropia and amblyopia rates may not significantly differ between early and delayed intervention for congenital nasolacrimal duct obstruction in this retrospective cohort presenting beyond 9 months of age to a children’s hospital.
What feels like a brain tumor, acts like a brain tumor, but isn’t a brain tumor? Pseudotumor cerebri! The Idiopathic Intracranial Hypertension Trial (IIHT) sought to determine the effect of acetazolamide in reducing visual loss symptoms after 6 months of treatment, in conjunction with the standard diet and weight loss. Patients with a new diagnosis of IIH by modified Dandy criteria (aged 18-60 years), excluding those with previous IIH or IIH for more than 2 weeks, were randomized to two groups: placebo (n = 79) or acetazolamide (n = 86) for 6 months.
The IIHT showed that acetazolamide is effective medical therapy, both for lowering intracranial pressure and for treating the visual field defect of moderate idiopathic intracranial hypertension vision loss/papilledema. Normally the limitation to high doses are the side effects, and the side effects seen in this trial were known, such as paresthesia of the extremities, a metallic taste in the mouth, fatigue, and frequent urination. Acetazolamide, as well as weight loss, is the first-line treatment for IIH.
A 79-year-old male with no significant past ocular history presented with progressively worsening blurry vision in both eyes over a period of several years. He described the vision as cloudy and explained difficulty seeing in poorly lit rooms. He also reported difficulty with watching TV and noted worsening glare and halos with lights, making nighttime driving unsafe. He is currently retired but worked as a metal welder for most of his life. On exam, his IOP was 12 mmHg OD and 15 mmHg OS. Slit lamp examination and H&E staining of the anterior lens capsule are show.
Exposure to which of the following types of radiation most likely lead to these findings?
A. Ionizing radiation
B. Charged particle radiation
C. Infrared radiation
D. UV radiation
E. Microwave radiation