Current Issue

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In this week’s issue:

• Autorefractors are a low-cost alternative to subjective refraction
• Public health measures for COVID-19 may have helped reduce the spread of conjunctivitis
• Youtube videos may not be a reliable source of surgical education for training ophthalmologists

Ophthalmology

QuickSee Autorefractor as a Low-Cost Alternative to Subjective Refraction

Better one or better two? In this randomized cross-over clinical trial of 400 adult participants in Southern India, the investigators assessed the accuracy of the QuickSee portable autorefractor (AR) compared to standard subjective refraction (SR) and patient preference of glasses prescription by either method. They found that spherical equivalents were strongly correlated between SR and AR (r=0.97). Of the 75.2% of patients who completed follow-up, 50.5% preferred glasses prescribed with SR and 49.5% preferred glasses prescribed using AR (P=0.86). Self-reported patient experiences did not favor one form of refraction over another. This novel study supports the wider acceptability of the QuickSee autorefractor as an efficacious and low-cost mode of refraction. As such, the authors recommend that this autorefractor can reduce the global burden of uncorrected refractive errors by providing adequate refraction without the need to highly trained personnel in resource-limited and remote settings. 

JAMA Ophthalmology

COVID-related public health measures and the incidence of infectious conjunctivitis

Hand hygiene and social distancing don’t just help prevent COVID! In this study, researchers at the University of Washington set out to investigate how COVID-related mitigation measures impacted the population-level spread of conjunctivitis. To assess this, they examined internet search interest in conjunctivitis and reasons for visits to a single emergency department (ED) from January 2015 to February 2021. They compared the times before and after April 2020, when COVID mitigation measures were implemented across the country. After controlling for the total number of ED visits, they found that emergency department encounters for nonallergic conjunctivitis decreased by 37.3% (p<0.001), whereas emergency visits for corneal abrasion and posterior vitreous detachments were unchanged. Search interest in conjunctivitis decreased by 34.2% (p<0.001) since the implementation of public health measures. This work suggests that the same hygiene interventions that work for respiratory infections are useful for the prevention of conjunctivitis. Another important takeaway from this study is that the data directly from the emergency department was in agreement with the internet search results, indicating that analysis of internet search data may be a useful proxy for disease incidence in times when other information is unavailable.

British Journal of Ophthalmology

The Safety and Performance of a Surgically Implanted Suprachoroidal Intraocular Pressure Sensor

Sometimes, you just need a mate to check in on you – EYEMATE-SC might be the one for you. Continuous monitoring of IOP has been of great interest for glaucoma. The authors developed a telemetric IOP sensor (EYEMATE-SC) that can be surgically implanted into the suprachoroidal space. In this prospective, single-arm study, the authors found that of the 24 patients with open angle glaucoma, no serious or sight-threatening complications nor any device malfunctions occurred at the 6 month follow-up. The most common complication was a hyphema (9/24), but all spontaneously resolved after surgery. Although Goldmann Applanation and the EYEMATE initially differed in measurements, by the 6 month follow-up, no statistically significant difference between the two methods were found. Overall, this study is the first to show that a suprachoroidal sensor is safe and effective at continuous IOP measurements at a 6 month follow-up, but larger, more heterogeneous studies need to be done to fully validate the EYEMATE-SC.

American Journal of Ophthalmology

Simulator-Based Training in Ophthalmoscopy for First-Year Medical Students

Let’s take it back to our first year of medical school! Direct ophthalmoscopy is a highly advantageous skill to have, no matter the specialty. It allows doctors, either primary care or specialized, to evaluate for visual fundus findings early on, such as diabetic retinopathy and papilledema. Simulator-based learning has been suggested to generally improve technical skills in medical students, but the evidence is limited regarding direct ophthalmoscopy.  In this prospective, randomized, controlled trial of 39 first year medical students, investigators compared the results of simulator-based versus traditional training in direct ophthalmoscopy. Every student received 1 hour of didactic instruction for direct ophthalmoscopes and were divided into two randomized groups: simulator training (n=17) or supervised practice with peers [traditional method] (n=16). Training groups were analyzed by ophthalmologists via survey responses, grades, as well as observer and patient assigned scores. While the simulator group reported additional hours of practice (p=0.02), they ultimately received higher technique scores (p=0.034). Differences in assessment scores between the simulator and traditional groups were not significant. In addition, the simulator groups were less likely to incorrectly locate macular scars (p=0.013).  The results did not show a clear outcome difference between traditional and simulator training.

Orbit

Quality of Eyelid Ptosis Surgeries on YouTube

We all know the internet isn’t always reliable, but what about YouTube?

The majority of surgical trainees utilize surgical videos as educational tools, but videos on YouTube do not undergo a peer-review process, may not discuss surgical indication, can obscure key steps of the procedures, and lack information on surgical complications. Understanding the educational value of these videos is particularly important given the increase in online education during the COVID-19 pandemic. This was a study evaluating the quality, reliability, and accuracy of 38 videos demonstrating ptosis surgery on YouTube. Multiple scoring methods were used. 42.1% of the videos were of good quality based on their surgical score and 78.9% were of very poor or poor quality based on their DISCERN score (a tool to evaluate the suitability and objectivity of treatment options). The mean Journal of the American Medical Association (JAMA) score indicated poor video quality, but the mean Global Quality Scoring (GQS) system score indicated moderate quality. The results of this study suggest that trainees and surgeons cannot rely on YouTube to provide high-quality educational information on ptosis surgery and highlights the need for reliable evaluation methods to ensure that viewers can access quality content.

Journal of Neurology, Neurosurgery, and Psychiatry 

Retinal inter-eye difference and atrophy progression in multiple sclerosis diagnostics 

OCT may now be able to diagnose multiple sclerosis (MS). Neurologic damage that is disseminated in space and time represent a classic presentation of MS. It has recently been proposed that optical coherence tomography (OCT) may be sensitive in detecting retinal asymmetry that is characteristic of MS-associated optic neuritis. In this prospective longitudinal study, 27 healthy control subjects and 151 multiple sclerosis patients underwent OCT assessment at baseline, 2 years, and 4 years. The results indicate that differences of the inner retinal layer thickness between the right and left eye, a measure of retinal asymmetry, had good diagnostic accuracy for previous episodes of MS-associated optic neuritis. The results from this study support the use of OCT as an additional clinical test for the diagnosis of MS.

1. In a survey of oncologists and pathologists who manage retinoblastoma, 100% of respondents noted which of the following to be a high-risk feature of retinoblastoma?

A. Post-laminar optic nerve infiltration

B. Pre-laminar optic nerve infiltration

C. Iris infiltration

D. Anterior chamber seeding

2. True or False: There was no significant difference in best corrected visual acuity in a 52-week period for neovascular AMD patients treated with Ranibizumab (brand name Lucentis) versus its biosimilar (SB11).

A. True

B. False

3. What was the key outcome of a randomized study where patients chose glasses prescriptions based on results from standard subjective refraction versus autorefraction?

A. Patients preferred standard subjective refraction

B. Patients preferred autorefraction

C. Patients were ambivalent between the two

4. True or False: hyperosmolar drops lead to a clinically (and statistically) significant reduction in early morning corneal edema.

A. True

B. False

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