• Journal Highlights

    Ophthalmology

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    Impairments in Dark Adaptation in AMD Patients

    October Ophthalmology

    Flamendorf et al. investigated dark adaptation (DA) in patients with age-related macular degeneration (AMD). They found that impairment in DA was associated with a number of factors, including the presence of reticular pseudodrusen, greater severity of AMD, and decreased subfoveal choroidal thickness.

    For this cross-sectional observational study, the researchers recruited 116 participants with AMD who were older than age 50 and had a best-corrected visual acuity (BCVA) of 20/100 or better in their study eye. Patients with advanced AMD in both eyes at baseline were excluded, as were those with any other active ocular or macular disease (e.g., glaucoma or diabetic retinopathy).

    The investigators used a prototype of the AdaptDx dark adaptometer to measure DA via rod intercept time (RIT). Study eye imaging was graded for the presence of reticular pseudo-drusen, and subfoveal choroidal thickness was measured manually on optical coherence tomography scans.

    Increased RIT was associated with greater AMD severity, increased age, poorer BCVA, pseudophakia, and decreasing subfoveal choroidal thickness. Moreover, patients with reticular pseudodrusen had a greater mean RIT than did those without pseudodrusen; this association held true across all AMD severity groups. This finding complements those from previous studies linking reticular pseudodrusen with rod dysfunction, the authors said.

    Electronic Health Records: Financial Return and Effect on Productivity

    October Ophthalmology

    Wiggins et al. presented a detailed financial analysis of 1 practice’s experience with the implementation of electronic health records (EHR). They found that their EHR program produced financial and operational benefits over a 5-year period.

    At the time of this data capture (2007-2011), the practice had 11 ophthalmologists, 2 optometrists, and 3 locations in western North Carolina. All providers had been in practice for 3 or more years in the community and had full clinic schedules.

    During the first month of implementation, patient load was reduced for 7 of the providers; after this, all schedules returned to baseline. During the second, third, and fourth years, there were no schedule changes. However, during the fifth year, there was a net annual increase in productivity. The authors attribute this to greater familiarity with the EHR program and a greater proportion of returning patients, which decreased the amount of new data entry. They also note that the entire staff took the opportunity to examine workflow efficiency throughout the 5-year period, which led to reductions in staffing in the areas of medical records, transcription, billing, checkout, and appointment scheduling.

    The authors point out that although their experience may not translate to other practices, their method of analyzing revenue and expenses may be helpful to those contemplating purchasing an EHR program.

    Risk Factors, Outcomes for Multidrug-Resistant Pseudomonas Keratitis

    October Ophthalmology

    Vazirani et al. set out to identify risk factors for multidrug-resistant Pseudomonas aeruginosa (PA) keratitis and to report associated clinical characteristics and outcomes of infection.

    For this retrospective case-control study, the researchers identified 90 episodes of PA keratitis that occurred from 2007 through 2014 at a tertiary care institution. Episodes of multidrug-resistant infections (n = 23) were designated as cases; episodes of drug-sensitive infection (n = 67) served as controls. A number of potential risk factors were evaluated, including age and sex of patient, use of topical steroids or lubricant ointments, history of trauma or ocular surgery, and use of a bandage contact lens.

    The authors found that the risk factors for multidrug-resistant PA keratitis are use of a lubricant ointment, presence of a compromised ocular surface, and use of a bandage contact lens. As expected, patients with the drug-resistant form of the infection had poorer outcomes than did those whose keratitis responded to treatment.

    The authors recommend culturing all topical medications used by patients with drug-resistant keratitis; in addition, they state that culture of corneal scraping samples and antimicrobial drug sensitivity testing are essential in managing this infection. Antimicrobial susceptibility testing in vitro showed that colistin and imipenem are the most effective drugs against multidrug-resistant PA, but they are not available in ophthalmic formulations.

    Intraoperative OCT in Children With Anterior Segment Anomalies

    October Ophthalmology

    Siebelmann et al. reported on their experience with intraoperative optical coherence tomography (OCT) in examining and performing surgery on infants and young children with anterior segment anomalies. They found that use of an operating microscope–mounted OCT device enabled visualization of all relevant anterior segment structures, even in patients with opaque corneas. With this technology, they were able to make diagnostic and therapeutic decisions that would not otherwise be possible; in particular, they were able to avoid unnecessary intraocular surgery in several patients. 

    This small case series involved 7 children with anterior segment abnormalities (4 corneal opacities, 1 brittle cornea, and 2 cataracts) who underwent either corneal or cataract surgery. All examination and surgical procedures were performed under general anesthesia.

    The authors said that intraoperative OCT was useful in allowing detailed examination of children, particularly those with a restricted view of the anterior chamber. It also permitted differentiation between corneal scars or keloids and Peters anomaly. Further, by providing ongoing monitoring during surgery, it facilitated timely treatment decisions in the OR.

    The image quality was limited in 1 eye, which had dense corneal scar tissue, retrocorneally attached iris tissue, and no anterior chamber. The authors suggested that extending the imaging wavelengths to achieve deeper penetration might be helpful in such challenging cases.

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    Ophthalmology summaries are written by Jean Shaw and edited by Susan M. MacDonald, MD.

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