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  • Journal Highlights

    JAMA Ophthalmology

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    Google Glass During Scleral Buckling Surgery

    June JAMA Ophthalmology

    Rahimy and Garg detailed their intraoperative experience with using Google Glass to record scleral buckling surgery. They found that the device’s ability to transmit exactly what the surgeon sees—and in real time—holds promise for surgical teaching in the coming years.

    The researchers used Google Glass to record all steps of the scleral buckling procedure, including conjunctival peritomy, rectus muscle isolation, administration of the sub-Tenon block, external drainage of subretinal fluid, and anterior chamber paracentesis with intravitreal gas tamponade injection. To protect patient privacy, they deactivated the device’s connection to the Internet while it was being charged and deleted any multimedia that automatically synced to Google’s backup servers during the surgical procedure.

    The researchers found that the still images and video clips provided adequate details for viewers who were not present during the surgery to recognize the salient steps of the procedure. The simultaneous audio recordings obtained from the video were also clear and audible upon playback. Several factors, however, limited the optimal image and video quality. For example, the bright illumination provided by the high-intensity overhead OR lamps occasionally overexposed the areas of interest. In addition, the absence of a flash resulted in decreased image quality in low-lighting environments. Finally, the camera’s wide-angle lens, combined with the lack of any zoom capabilities, led to a decreased size of the operative field.

    Electronic Health Record System Implementation

    June JAMA Ophthalmology

    In a retrospective case-control study, Singh et al. examined the clinical and economic impact of implementing an electronic health record (EHR) system in a large multispecialty ophthalmic practice. They did not identify any differences in revenue or productivity following EHR conversion, nor did the EHR incentive payments fully offset the costs of implementation.

    The researchers compared total revenue, total visit volume, revenue per visit, coding volumes, and the number of diagnostic tests and procedures performed at the Cole Eye Institute for pre- and post-EHR time periods. They also evaluated the total cost of EHR implementation and the expected return in EHR incentive payments.

    A total of 28,161 patient encounters were identified between April 1, 2011, and April 5, 2013 (13,969 in the pre-EHR period and 14,191 in the post-EHR period). The researchers identified no changes in total net fiscal revenue, patient volume, revenue per visit volume, and volume of billable diagnostic tests and procedures after EHR implementation. They also found that overall use of Eye codes declined (−15.7%), while the use of E&M codes increased (14.7%).

    Total capital and personnel costs for implementation amounted to $1,571,864 and $1,514,334, respectively, and the researchers expected to receive $983,103 from meaningful use attestation by 2016. They concluded that the progress of EHRs should be further monitored to ensure long-term stability in operating revenue and volume.

    Prediction of Juvenile-Onset Myopia

    June JAMA Ophthalmology

    As part of the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study, Zadnik et al. investigated multiple predictors for myopia onset in school-age children and found cycloplegic spherical equivalent refractive error to be the best single predictor of future myopia.

    This study was conducted at 5 clinical sites from Sept. 1, 1989, through May 22, 2010, and included data from 4,512 ethnically diverse, school-age children from grades 1 through 8. The researchers defined myopia onset as follows: −0.75 D or more of myopia in each principal meridian of the right eye as measured by cycloplegic autorefraction during any visit after baseline until grade 8. They then evaluated risk factors using odds ratios from discrete time survival analysis, the area under the curve, and cross-validation.

    A total of 414 children became myopic from grades 2 through 8 (ages 7 through 13 years). Of the 13 predictive factors evaluated, 10 were associated with the risk for myopia onset. Of these 10 factors, 8 retained their association in multivariate models: spherical equivalent refractive error at baseline, parental myopia, axial length, corneal power, crystalline lens power, ratio of accommodative convergence to accommodation, horizontal/vertical astigmatism magnitude, and visual activity. The researchers found that a less hyperopic/more myopic baseline refractive error was consistently associated with risk of myopia onset in multivariate models, while near work, time outdoors, and having myopic parents were not. Spherical equivalent refractive error was the best predictive factor, performing as well as all other factors combined, with an area under the curve ranging from 0.87 to 0.93.

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    JAMA Ophthalmology summaries are based on authors' abstracts as edited by senior editor(s).

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